儿童完全植入式静脉输液港日间手术策略的选择和体会

Selection and experience of day surgery strategy for totally implantable venous access port in children

目的比较同期儿童完全植入式静脉输液港(totally implantable venous access port,TIVAP)日间手术和住院手术情况,探讨开展儿童TIVAP植入日间手术的可行性。方法收集2015年4月至2020年4月在重庆医科大学附属儿童医院肿瘤外科接受TIVAP植入术的516例患儿的相关资料。其中,男311例,女205例;将321例接受日间手术的患儿作为日间手术组;将195例接受住院手术的患儿作为住院手术组。通过电子病历(electronic medical record,EMR)和医院信息系统(hospital information system,HIS)收集两组患儿的病史资料和手术情况,通过互联网医院、微信或者电话定期随访患儿TIVAP使用情况和主要并发症的发生情况。比较两组患儿住院天数、总费用和术后并发症情况。结果13例日间手术组和8例住院手术组患儿锁骨下静脉穿刺置管失败改为颈内静脉入路,两组之间的差异无统计学意义(P<0.05)。本研究所有TIVAP植入术成功。日间手术组住院时间为(1.00±0)d,住院手术组为(5.40±1.69)d,两组之间的差异具有统计学意义(P<0.01)。日间手术组总费用为(13125±568)元,住院手术组为(16125±1035)元,均除外其他疾病的治疗费用,两组之间的差异具有统计学意义(P<0.001)。术后主要并发症包括导管相关性血行感染、导管堵塞、港体周围皮肤感染和非计划取港,并发症的发生率在两组之间的差异无统计学意义。结论儿童TIVAP植入日间手术是高质量、低成本的治疗模式,具有推广使用价值。

Objective To compare the day surgery versus hospital surgery of totally implantable venous access port(TIVAP)during the same period and to explore the feasibility of day surgery for TIVAP implantation in children.Methods From April 2015 to April 2020,the relevant clinical data were collected from 516 children undergoing TIVAP implantation at Department of Oncology,Children's Hospital,Chongqing Medical University.There were 311 boys and 205 girls.And 321 children undergoing day surgery were selected as day surgery group and 195 children undergoing inpatient surgery as inpatient surgery group.Medical history and surgical profiles of two groups were collected through electronic medical record(EMR)and Hospital Information System(HIS).Using of TIVAP and occurrence of major complications were regularly followed up by Internet hospital,WeChat or telephone.Hospitalization stay,total expenditure and postoperative complications were compared between two groups.Results Thirteen children in day surgery group and 8 in inpatient surgery group failed to catheterize subclavian vein and switched to internal jugular vein approach.There was no statistically significant inter-group difference(P<0.05).All TIVAP implantations were successful.Hospitalization stay was(1.00±0)day in day surgery group and(5.40±1.69)days in inpatient surgery group and the inter-group difference had statistical significance(P<0.01).The total expenditure was(13125±568)yuan in day surgery group and(16125±1035)yuan in inpatient surgery group(excluding treatments for other diseases)and the inter-group difference had statistical significance(P<0.001).Major postoperative complications included catheter-related bloodstream infection,catheter occlusion,peri-port skin infection and unplanned port removal.And the inter-group incidence of complications was not significantly different.Conclusions Daytime surgery for TIVAP implantation is superior with a low expenditure in children.It is worthy of wider promotions and applications.