超声联合DSA引导下经上臂静脉输液港植入术在恶性肿瘤化疗患者中的临床应用研究

Clinical application of ultrasound combined with DSA-guided implantation of totally implantable venous access port via upper arm vein approach in chemotherapy for patients with malignant tumors

目的 探讨超声联合DSA引导下经上臂静脉植入式输液港(TIVAP)作为恶性肿瘤患者化疗通路的安全性和有效性。方法 回顾性分析2020年1月至2022年1月上海交通大学医学院附属仁济医院1 546例接受经上臂TIVAP的恶性肿瘤患者临床资料,分析比较PICC置管室和DSA手术室实施该手术的植入成功率、一次置管成功率、手术时间和并发症率。结果 1 546例患者植入成功率100%,一次置管成功率99.48%;手术时间(22.7±3.1) min;总并发症率7.37%(114/1 546);置管室操作766例,DSA下操作780例,与置管室组比较,DSA组手术时间更短[(20.1±1.3) min vs (25.4±1.9) min],原发导管异位发生率更低(0%vs 0.78%),差异有统计学意义(P<0.05)。感染、血栓形成、上肢运动障碍、导管堵塞、港体外露、港体翻转等并发症两组间比较无统计学差异(P>0.05)。结论 超声引导下经上臂TIVAP对肿瘤化疗患者是一种安全有效的输液通路,联合术中DSA引导可减少手术时间,降低手术相关并发症率。

Objective To evaluate the technical feasibility and safety of upper arm vein approach in the implantation of totally implantable venous access port(TIVAP)under the guidance of ultrasound combined with DSA.Methods The clinical data of 1546 patients with malignant tumors,who received TIVAP implantation via upper arm vein access under the guidance of ultrasound combined with DSA at the Affiliated Renji Hospital,School of Medicine of Shanghai Jiao Tong University of China between January 2020 and January 2022,were retrospectively analyzed.The implantation success rate,single-puncturing success rate,operation time,and complications were compared between the PICC catheterization room and the DSA operating room.Results The technical success rate in the 1546 patients was 100%,with a single-puncturing success rate of 99.48%.In 766 patients the TIVAP implantation was performed in the PICC catheterization room(PICC group),and in 780 patients the TIVAP implantation was carried out in the DSA operating room(DSA group).The mean operation time in the DSA group was(20.1±1.3)min,which was obviously shorter than(25.4±1.9)min in the PICC group,and the incidence of primary catheter misplacement in the DSA group was 0%,which was remarkably lower than 0.78%in the PICC group(P<0.05).No statistically significant differences in the incidences of complications,including infection,thrombosis,upper limb movement disorder,catheter occlusion,existed between the two groups(P>0.05).Conclusion Ultrasound-guided TIVAP via upper arm vein approach is a safe and effective infusion route for patients with malignancy receiving chemotherapy.The combination use of ultrasound guidance and intraoperative DSA guidance can reduce the operation time as well as the incidence of operation-related complications.