经皮输液港植入术后并发症的总结分析

Summarize and analyze the complications after percutaneous venous access port implantation

目的分析总结静脉输液港植入后出现的相关并发症。方法回顾性分析2017年1月至2019年12月徐州医科大学附属徐州市立医院收治的90例植入完全植入式静脉输液港(TICVP)的患者的临床资料,以超声联合数字减影血管造影(DSA)作为引导,通过不同途径植入输液港,总结术后出现的手术部位出血及血肿、堵管事件、切口不愈合、导管移位、港体移位、港体皮肤溃烂、裂开及夹闭综合征等并发症,追溯导致并发症的原因。结果90例TICVP植入术后的患者,手术部位出血及血肿3例、发生堵管事件3例、切口不愈合1例、导管移位2例、港体移位0例、港体皮肤溃烂、裂开1例、夹闭综合征1例、切口感染1例、瘢痕形成2例。手术部位出血及血肿停用抗凝、抗血小板药物并加压处理后恢复良好;堵管事件中使用尿激酶导管内溶栓后恢复通畅,导管内溶栓无效,则被迫取港;港体皮肤裂开、溃烂选取肩关节内下方皮下组织稍多处放置港体,亦可放置于上臂;切口不愈合通过营养支持和补充白蛋白并延长拆线时间,切口愈合良好;导管移位通过腔内导管技术,恢复导管的正常位置;夹闭综合症将面部转向左侧,滴速改善。结论TICVP植入术后发生并发症患者较少,通过总结术后相关并发症发生原因,使TICVP植入更加安全、可靠,避免并发症的发生,值得临床推广应用。

Objective To analyze and summarize the complication after implanting the port in the vein.Methods Clinical data of 90 patients with totally implantable central venous port(TICVP)admitted to Xuzhou Municipal Hospital of Xuzhou Medical University from January 2017 to December 2019 were retrospectively analyzed,ultrasound combined with digital subtraction angiography(DSA),TIVAP was implanted through,the postoperative complications such as bleeding and hematoma at the surgical site,plugging events,incision nonunion,catheter displacement,port body displacement,port body skin ulceration,dehiscence and clamping syndrome were summarized,and the causes of complications were traced back.Results Among the 90 patients after TICVP implantation,there were 3 cases of surgical site bleeding and hematoma,3 cases of tube plugging,1 case of incision nonunion,2 cases of catheter displacement,0 cases of port body displacement,body skin ulceration and dehiscence of port body,1 case of clamp syndrome,1 case of incision infection,and 2 cases of scar formation.Surgical site bleeding and hematoma recovered well after discontinuation of anticoagulant and antiplatelet drugs and compression treatment;in the event of catheter occlusion,catheter thrombolysis with urokinase was used to restore patency,but catheter thrombolysis was ineffective,and the port was forced to remove;for skin degranulation and ulceration,the port should be placed at slightly more subcutaneous tissue in the inner and lower part of the shoulder joint,and the port can also be placed in the upper arm;the non-healing incision healed well by nutritional support,albumin supplementation and prolonging the time of stitching removal;catheter displacement was restored to the normal position through the intracavitary catheter technique;the clipping syndrome turns the face to the left and the drip rate improves.Conclusion There are few patients with complications after TICVP implantation.By summarizing the causes of postoperative complications,TICVP implantation can be safer and more reliable and avoid complications,which is worthy of clinical promotion and application.