3种不同途径植入静脉输液港的临床应用比较

Comparative clinical application of implantable venous-access port with three different surgery approaches

目的比较3种不同途径(锁骨下静脉锁骨下、锁骨下静脉锁骨上及颈内静脉入路)完全植入性静脉输液港的临床应用、并发症及非计划取港情况。方法回顾性分析2013年12月至2019年10月份宜兴市人民医院介入肿瘤科556例植入静脉输液港病例资料,按不同植入途径分为3组:锁骨下静脉锁骨下入路组(A组),锁骨下静脉锁骨上入路组(B组),颈内静脉组(C组),比较3组患者术后并发症及非计划取港情况。结果未发现年龄、性别、输液港位置、肿瘤类型,输液港的用途、定期维护与并发症有相关性。A组(169例)发生并发症23例(13.61%),包括气胸5例,囊袋血肿2例,夹闭综合征6例,导管移位3例,输液港感染3例,港座外露2例,导管相关血栓1例,纤维蛋白鞘1例,非计划取港11例(6.51%)。B组(174例)发生并发症11例(6.32%),包括囊袋血肿1例,导管移位2例,输液港感染2例,导管断裂1例,港座外露3例,导管相关血栓1例,纤维蛋白鞘1例,非计划取港8例(4.60%)。C组(213例)发生并发症16例(7.51%),包括囊袋血肿1例,纵膈血肿1例,导管移位3例,输液港感染3例,切口裂开1例,港座外露3例,导管相关血栓2例,纤维蛋白鞘2例,非计划取港10例(4.69%)。3组在非计划取港率上差异无统计学意义,3组并发症两两比较显示A组有发生率更高的趋势(P=0.024,P=0.051)。结论3种途径均可为患者提供长期安全有效的输液通道,锁骨下静脉锁骨下入路并发症发生率更高(尤其表现为气胸及夹闭综合征),如需避免此两类并发症可优选另两种途径。

Objective To compare the clinical application,complications and unplanned port removal of total lyimplanted central venous-access port devices(TIVAP)with three different approaches(subclavian vein via subclavian,subclavian vein via supraclavicular,and internal jugular vein).Methods Clinic data of 556 cases implanted central venous access port devices in the Department of Interventional Radiology and Oncology,Yixing People’s Hospital between Dec.2013 and Oct.2019 were analyzed retrospectively.The patients were divided into three groups according to the different catheter implantation sites,subclavian vein via subclavian approach(group A),subclavian vein via supraclavicular approach(group B)and internal jugular vein approach(group C)and to compare the complications and unplanned port removal.Results We didn’t find any correlations between age,gender,infusion port location,tumor type,purpose of port,regular maintenance and complications.In group A,complications occurred in 23 of 169 patients(13.61%),including 5 cases of pneumothorax,2 cases of pocket hematoma,6 cases of pinch-off syndrome,3 cases of catheter migration,3 cases of TIVAP related infection,2 cases of port exposure,1 case of catheter thrombosis or occlusion and 1 case of fibrin sheath,and 11 cases were unplanned removed(6.51%).In group B,complications occurred in 11 of 174 patients(6.32%),including 1 cases of pocket hematoma,2 cases of catheter migration,2 cases of TIVAP related infection,1 case of catheter fracture,3 cases of port exposure,1 case of catheter thrombosis or occlusion,1 case of fibrin sheath,and 8 cases were unplanned removed(4.60%).In group C,complications occurred in 16 of the 213 patients(the rate was 7.51%),including 1 case of pocket hematoma,1 case of mediastinal hematoma,3 cases of catheter migration,3 cases of TIVAP related infection,1 case of wound dehiscence,3 cases of port exposure,2 cases of catheter thrombosis or occlusion,2 cases of fibrin sheath,and 10 cases were unplanned removed(4.69%).There were no significant differences about unplanned port removal rate among the 3 groups.Pairwise comparison indicated that group A had higher complication tendency(P=0.024,P=0.051).Conclusion The three different operation approaches of TIVAP are safe and effective for long term intermittent venous access.The complication rates were higher tendency in subclavian vein via subclavian approach than other two approaches,especially happening in pneumothorax and pinch-off syndrome.If you wantto aviod these two types of complications,the other two approaches could be chosen priority.