经颈内静脉入路植入静脉输液港原发性导管异位的处理

Management of primary catheter malposition following totally implantable venous access port implantation via the internal jugular vein

目的探讨经颈内静脉(IJV)入路植入静脉输液港(TIVAP)发生原发导管异位(PCM)的特征与处理。方法回顾性分析2017年8月至2022年8月在郑州大学第一附属医院乳腺外科单一治疗组连续收治的经IJV入路植入TIVAP的587例乳腺癌患者的临床资料。结果经IJV入路共植入593例胸壁TIVAP,发生PCM 18例(3.0%)。其中经右侧入路425例,PCM 1例(0.2%)。经左侧入路168例,PCM 17例(10.1%)。18例PCM中11例首选猪尾巴导管介入调整,10例成功,1例失败;3例首选数字减影血管造影(DSA)下开放调整,均成功;4例首选盲视下开放调整,2例成功,2例失败。结论经左侧颈内静脉入路植入TIVAP的PCM发生率明显高于右侧,应用猪尾巴导管介入调整或DSA下开放调整是处理PCM的可行方法。

Objective To investigate the characteristics of primary catheter malposition(PCM)following totally implantable venous access port(TIVAP)implantation via the internal jugular vein(IJV)and management strategies.Methods Clinical data of 587 consecutive breast cancer patients undergoing TIVAP implantation via the IJV performed by single team at the Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University from Aug 2017 to Aug 2022 was retrospectively analyzed.Results A total of 593 TIVAP were implanted and PCM was found in 18 cases(3.0%).Four hundred and twenty five TIVAP were implanted via the right IJV with one PCM case(0.2%).One hundred and sixty eight TIVAP implantations were performed via the left IJV and PCM occurred in 17 cases(10.1%).The interventional management with a pigtail catheter was performed as a first-line strategy in 11 of the 18 PCM cases,with a success in 10 cases and failure in one.Three cases were successfully managed with the digital subtraction angiography(DSA)-guided open approach.Four cases underwent blind open procedure firstly and 2 suffered a failure.Conclusions A higher incidence of PCM is found in TIVAP implantations via the left IJV than the right one.The interventional management with a pigtail catheter or the DSA-guided open procedure proves to be feasible for the correction of PCM.