上臂静脉与锁骨下静脉入路输液港应用于胃肠肿瘤化疗的并发症比较

Upper arm vein versus subclavian vein for totally implantable venous access ports for patients with gastrointestinal malignancy： a retrospective comparison of complications

目的比较经上臂静脉与锁骨下静脉两种入路完全植入式输液港应用于胃肠肿瘤患者化疗的并发症。方法回顾性分析2013年9月至2015年1月间在中山大学附属第六医院肿瘤内科行输液港植入的208例患者的临床资料，其中上臂静脉入路组86例，锁骨下静脉入路组122例。比较两组患者植入术后早期及远期并发症发生情况。结果所有输液港均成功植入。上臂静脉入路组与锁骨下静脉入路组早期总并发症发生率的差异无统计学意义f22．1％（19／86）比17．2％（21／122），P=0．38]；其中上臂静脉组导管异位的发生率高于锁骨下静脉组[14．0％（12／86）比5．7％（7／122），P=0．04]，但这些异位的导管均可在x线透视下调整到正确位置。上臂静脉入路组远期总并发症发生率明显低于锁骨下静脉组[7．0％（6／86）比27．0％（33／122），P=0．01）；其中上臂静脉组输液不畅发生率低于锁骨下静脉组[1．2％（1／86）比9．8％（12／122），P=0．02]。结论与锁骨下静脉植入方式相比，上臂静脉输液港术后远期并发症更低，是一种安全、舒适的植入方式。

Objective To compare two different routes of totally implantable venous access ports （TIVPs） from the upper arm vein and the subclavian vein in terms of complications for patients with gastrointestinal malignancy. Methods Patients who underwent implantations of TIVPs from September 2013 to January 2015 were retrospectively evaluated. The outcome measurements were rates and types of postprocedural early-stage and long-term complications. Results A total of 208 patients（upper arm vein group, 86; subclavian vein group, 122） were included in this study. All TIVPs were implanted successfully. The rate of catheter displacement was higher in upper arm vein group （14.0% vs 5.7%, P=0.04）, while other postprocedural early-stage complications had no significant difference between the two groups. The occurrence of transfusion obstacle and rates of overall postprocedural longterm complications were significantly lower in upper arm vein group than that in subclavian vein group （1.2% vs. 9.8%, P=0.02; 7.0% vs. 27.0%, P=0.01, respectively）. Conclusion Compared with subclavian vein group, upper arm vein group has lower postprocedural long-term complication rates and is recommended as a safe and comfortable choice for port implantation.