静脉输液港导管断裂防治

Prevention catheter fracture in totally implantable central venous access ports

目的探讨静脉输液港导管断裂的防治。方法对2007年9月—2012年3月诊治的4例静脉输液港导管断裂病例临床资料进行回顾性分析，并结合国内外文献进行讨论。结果患者年龄32—75岁，平均58岁。2例女性均为乳癌根治术后，2例男性分别为乙状结肠癌根治术后及胃癌根治术后。发现导管断裂时间分别为置入术后3个月、6个月、8个月及10年，均为导管与底座接头处断裂；其中3例远断端无移位，局部麻醉手术取出，1例远断端导管移位至下腔静脉，急诊经介入方法取出。1例患者化疗期间行损坏输液港取出术同时，经对侧头静脉途径再次置入全新输液港。所有取出导管均完整，所有患者术后均观察2周，无并发症发生。结论夹闭综合征是引起静脉输液港导管断裂的主要原因，合理选择置入方法可降低其发生率。一旦导管断裂并移位，首选经股静脉介入方法取出。

Objective To discuss the prevention of catheter fracture in totally implantable central venous access ports （ TI- VAD）. Methods The clinical data of 4 cases of catheter fracture in TIVAD between September 2007 and March 2012 were analyzed retrospectively ,The related literatures were also reviewed. Results The age was 32 to 75 years, mean 58 years. 2 female patients had undergone radical mastectomy ,2 male patients had undergone radical resection sigmoid colon cancer and radical gastrectomy for cancers. The catheter fracture occurred on 3 months, 6 months, 8 months and 10years after TIVAD, respectively, the fracture was all located in the anastomosis between reservoir and catheter. There was no catheter migration in 3 cases of catheter fracture ,and the damaged device was removed via the previous wound site under local anesthesiology. The distal fragment embolized into the inferior vena cava in 1 case, and the damaged device was re- moved by a percutaneous approach using a goose neck snare catheter. The new TIVAD was implanted via percutaneous ce- phalic vein approach at the same day after the damaged device was removed. All reservoirs and fractured catheters were removed successfully ;2 weeks of follow up showed no complications. Conclusion Pinch-off syndrome was the main cause of catheter fracture in TIVAD. The feasible implantation of TIVAD can decreased the incidence of catheter fracture. For the migrated damaged device, the percutaneous removal of the catheter with a goose neck snare catheter was the first of choice.