完全植入性中心静脉输液港植入术在乳腺癌病人中的应用

Application of totally implanted venous access ports in breast cancer patients

目的探讨完全植入性中心静脉输液港并发症的发生、预防和处理方法。方法提取接受输液港植入手术的158例乳腺癌病人的临床资料,总结分析输液港的放置方法、留置时间、并发症的种类和处理方法。结果输液港的放置方法包括:乳腺癌术中经腋静脉植入50例、经锁骨下静脉穿刺植入101例、经颈内静脉穿刺植入7例。输液港留置时间21~1 416 d,平均245.2 d。并发症包括:注射座局部感染破溃3例(1.9%,95%CI:0.39~5.45),导管断裂3例(1.9%,95%CI:0.39~5.45),导管破裂1例(0.6%,95%CI:0.02~3.48),导管异位1例(0.6%,95%CI:0.02~3.48),输液不畅2例(1.3%,95%CI:0.015~4.5)。3例注射座局部感染和2例导管断裂的病人提前取出输液港,其余1例导管断裂发生在取管术中,断裂的远端导管均采用介入手术取出。导管破裂在取管术中发现,导管异位在计划取管术前拍摄X片发现,2例病人均无症状。结论完全植入性中心静脉输液港是乳腺癌病人可选择的长期静脉通路,感染和导管断裂是导致非正常取港的主要原因。介入手术取出断裂导管损伤小、安全可靠。

Objective To investigate the occurrence, prevention and treatment of complications related to totally implanted venous ac-cess port. Methods Clinical data of 158 breast cancer patients who adopted totally implanted venous access ports. Operation methods, catheter life and treatments for complications were analyzed. Results Three methods were used to implant port including implantation via axillary vein in the operation of breast cancer （50 cases） ,implantation through puncture of subclavian vein （ 101 cases） and im-plantation through puncture of internal jugular vein （7 cases） . Catheter life ranged from 21 to 1 416 days with a mean of 245. 2 days. Complications includepocket infection in 3 cases （1.9% ,95% C/： 0. 39-5. 45 ） , rupture of catheter in 3 cases （ 1 .9 % ,95% CI： 0. 39-5.45） ,fracture of catheter in 1 case （ 0. 6% ,95% C/： 0. 02-3. 48 ） , catheter malposition in 1 case （ 0. 6% ,95% C /： 0. 02-3. 48 ） , and infusion difficulty in 2 cases （ 1.3% ,95% C/： 0. 015^1. 5 ） . Three ports were removed for failure of conservative anti-infection treatment for pocket infection,and two for puncture of catheter,the third catheter puncture occurred during the operation. For 3 cases with punc-ture of catheter,distal catheters were retrieved by intervention operation. The catheter fracture was found in the catheter removal opera-tion. The catheter malposition was found by X-ray before the planned removal operation. For both the two cases,there were no symptoms associated with the complications. Conclusions Totally implanted venous access port can be used for long-time intravenous therapy for breast cancer patients. Infection and catheter puncture are the main causes ofunexpected explantation of port. It is safe and reliable to retrieve distal fractured catheters by intervention operation with minor tissue damage.