超声引导下经腋静脉输液港植入术的临床应用

Ultrasound-guided venous access port implantation via axillary vein

目的探讨超声引导下经腋静脉放置完全植入式静脉输液港(TIVAP)的手术技巧及临床应用安全性。方法回顾性分析重庆医科大学附属第一医院内分泌乳腺外科于2016年9~12月收治的40例经腋静脉植入TIVAP化疗的乳腺癌患者(研究组)临床资料,其中15例经左侧腋静脉植入TIVAP,25例经右侧腋静脉植入TIVAP。并以同期50例经右侧颈内静脉穿刺留置TIVAP的患者作为对照组。分析2组患者的手术成功率、穿刺次数≤2次的比例和手术时间,以及术中、术后并发症的发生情况。2组间手术时间的比较采用t检验,率的比较采用Fisher确切概率法。结果超声引导下经腋静脉和颈内静脉途径放置TIVAP均获得成功,成功率均为100%(40/40,50/50)。研究组患者的手术时间稍长于对照组[(26±4)min比(22±3)min,t=-5.410,P<0.001],但是,2组患者间穿刺次数≤2次者的比例、术中气胸及动脉损伤发生率相比,差异均无统计学意义[97.5%(39/40)比96.0%(48/50),P=1.000;0(0/40)比2.0%(1/50),P=1.000;0(0/40)比4.0%(2/50),P=0.501],并且,2组患者间术后远期并发症发生率,如血栓发生率、感染发生率相比,差异也均无统计学意义[2.5%(1/40)比0(0/50),P=0.444;2.5%(1/40)比2.0%(1/50),P=1.000]。结论超声引导下经腋静脉穿刺植入TIVAP是一项安全、有效、并发症发生率相对较低的技术。

Objective To discuss the technical skill and clinical safety of ultrasound-guided implantation of totally implantable venous access port （TIVAP） via axillary vein. Methods We retrospectively analyzed the data of 40 breast cancer patients receiving chemotherapy via TIVAP （research group ） in Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University from September to December 2016. Fifteen patients were implanted with TIVAP via left axillary vein, and the other 25 were implanted with TIVAP via right axillary vein. Another 50 patients who received TIVAP via internal jugular vein served as control group. The successful rate, proportion of the patients with ≤ 2 punctures, operation time, intraoperative and postoperative complications were compared between 2 groups, t test was used to compare the operation time, and Fisher exact probability method was used to compare the rate. Results The implantation of TIVAP via axillary vein or internal jugular vein were performed successfully in all cases, with the successful rate of 100% （40/40, 50/50）. The operative time in research group was significantly longer than that in control group [ （26±4） rain vs （22±3） min, t= -5.410, proportion of the patients with ≤ 2 punctures, incidence of pneumothorax and P〈0. 001 ]. However, the incidence of arterial injury showed no significant difference between 2 groups [ research group vs control group： 97. 5% （39/40） vs 96.0% （48/50）, P=1.000; 0（0/40） vs2.0% （1/50）, P=1.000; 0（0/40） vs4.0% （2/50）, P= 0. 501 ]. There were no significant differences in thrombosis rate and infection rate between 2 groups [ research group vs control group： 2. 5% （1/40） vs 0（0/50）, P = 0. 444; 2. 5% （1/40） vs 2. 0% （ 1/50）, P= 1. 000 ]. Conclusion TIVAP implantation via axillary vein approach is a safe and effective technique with relatively low complication rate.