Port-A-Cath系统腹腔置入3例报告

1978年Dedcick等阐明了腹腔内化疗的药代动力学原理,接着又研制出对卵巢癌有较高敏感性的药物CODP。近年Port-A-Cath装置的问世,使腹腔化疗可在长时间内反复进行。

Complications from port-a-cath system implantation in adults with malignant tumors:A 10-year single-center retrospective study

Background:Port-A-Cath systems(PCS)are safe and convenient devices for long-term infusion in patients with malignant tumors.This study retrospectively analyzed the complications from PCS and their management.Methods:Data of 1695 adults(641 males and 1054 females)with malignant tumors who underwent PCS implantation in our center from January 1,2009 to December 31,2019 who had complete follow-up records were collected in this study.The early and late complications and corresponding treatments were studied.Results:A total of 1716 PCSs were implanted;21 patients underwent 2 implantations each.The success rate was100%and no severe complications occurred during implantation.The overall occurrence rate of post-implantation complications was 18.5%(318/1716);5.5%(94/1716)were early complications and 13.0%(224/1716)were late complications.A total of 451 PCSs were removed,of which 398 were removed due to the end of chemotherapy,while 53 were removed because of complications.A total of 4 deaths occurred from these complications.Conclusions:The incidence of intra-and post-operative complications is low.In most cases,complications can be effectively controlled without the removal of the PCS and regular follow-up and maintenance are critical.

Intravascular treatment for abnormal catheter positioning of port-a-cath system in the subclavian vein:A single-center study

Objective:This study aimed to explore the incidence of abnormal catheter positioning and the effectiveness and safety of intravascular adjustment or removal of abnormally positioned catheters through percutaneous punctures.Materials and methods:A retrospective analysis was conducted on 58 patients with abnormal catheter positioning,treated between January 2009 and June 2019.Intravascular adjustment of the migrated catheters and removal of the fractured catheters were performed through percutaneous puncture using a pigtail catheter,cobra catheter,and gooseneck snare.Results:Of the 58 cases,there were 23 cases of catheter migration and 35 cases of catheter fracture.The incidence of abnormal catheter positioning was 3.0%,corresponding to 1.2%migrations and 1.8%fractures.Among the 23cases of migration,1 case did not require adjustment and another underwent unsuccessful adjustment.The rate of successful adjustment of migrated catheters was 91.3%,whereas the rate of successful removal of fractured catheters was 100%.No surgery-related complications were observed either immediately or during the 1-month follow-up period.Conclusions:This study showed that the incidence of abnormal catheter positioning is low.Intravascular techniques used for the adjustment or removal of abnormally placed catheters are safe,efficient,and minimally invasive.

Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture

Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (PNX) in children. Aim: To construct a baseline value before the introduction of systematic use of ultrasound guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer Center;patients were children (age ≤ 18 years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia, utilizing a micropuncture 5-7 Fr needle and fluoroscopy. In the study period ultrasound was used only in case of previously failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December 2011, 452 catheters were implanted to our patients. The prevalent approach was from subclavian vein (left 85.7%, right 9.7%);in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred in 14 patients (3.1%;95%CI 1.9-5.1). In 4/14 children the PNX was considered minimal and not treated. In 10 patients the PNX was drained. In 7 cases a traditional, surgical thoracostomy was performed, while in 3 children a 14-Ga polyurethane catheter (Arrow International&#174) was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In our centre rates of PNX are the same as those described in literature and are expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.

Ultrasound Guided Port-A-Cath Implantation

Purpose: The use of port catheters is well accepted in the management of patients with malignancy. In this study, we compare the technical success and the complication rates of ultrasound guided Port-A-Cath implantation with doing this procedure by using the anatomical landmark method. Methods: In a retrospective study, from 2006 to 2009, medical files of 104 patients who had undergone Port-A-Cath implantation were reviewed. The indication for port catheter implantation was malignancy in all cases. Among our patients, Port-A-Cath implantation was done in 63 patients by using landmark method and in 41 patients by guidance of ultrasound. All patients had been observed for complications including pain, port infection, and port thrombus, thrombus of central veins, skin necrosis, and success in using of Port-A-Cath for at least one month following the procedure, in the vascular clinic. Results: in landmark method group, 2 catheters were non-functional just after placement (3.2%) while all Port-A-Caths in ultrasound-guided group were functional. Ten patients (15.9%) in land mark group and 1 patient (2.4%) in ultrasound-guided group were complicated. The difference between complication rate in anatomic landmarks method and ultrasound-guided method was statistically significant (p There was no significant difference in two groups in duration of port placement (p < 0.345), age (p < 0.444), site of port placement (p < 0.244) or type of malignancy (p < 0.18). Conclusion: Considering high rate of success and low complications in placement of Port-A-Cath with ultrasound guidance, this method is superior to the land mark method in patients with malignancy.

Extending the interval for port-a-cath maintenance

Objective: The objective of this study is to assess the outcome of port-a-cath (PAC) maintenance every three months in patients with gynecologic malignancies with the goal of standardizing a safe and appropriate interval that would maintain patency and minimize side effects. Methods: We performed a retrospective medical record review and evaluation of all patients with a Bard? PAC who were noted to have no evidence of disease (NED) during the years 2003 to 2010. The interval between accessions and any complications related to the presence of the PAC were recorded. Relevant complications included skin infections, bacteremia, thrombosis, and occlusions. Statistical analysis was done using the Fisher’s exact test. Results: A total of 201 patients had PAC placed and 43 patients underwent PAC accessions to maintain patency. The total number of accessions was 150 with a median number per patient of 2.0 (range 1 - 10). The mean time between flushes was 112 days (SD = 57). When comparing women in maintenance who had flushes within 90 days versus those who had flushes over 90 days apart, there was no difference in infection or occlusion rates between these groups (p = 0.515). In the Conclusion: Infections and occlusions are rare in women with gynecologic malignancies undergoing maintenance of their PAC. Longer intervals between PAC flushes do not appear to affect the outcome in our patients. Our ongoing data and follow-up confirm that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in the patient population with gynecologic malignancies.