CAJ | 학술논문

目的探讨完全植入式静脉输液港穿刺置管方式的成功率、并发症发生的原因及对策.方法回顾性分析2008年12月至2013年3月2 007例接受静脉穿刺置管的完全植入式静脉输液港手术患者的临床资料,包括2 005例恶性肿瘤患者和2例良性疾病患者,男性38例,女性1 969例;年龄21～ 85岁,平均年龄47.6岁.对穿刺方式、成功率,术中、术后并发症以及相关处理措施和治疗效果进行分层分析.结果患者带港时间为9～1 243 d,平均(242±12)d.右颈内静脉盲穿成功率最高(99.76％),左锁骨下静脉盲穿成功率最低(81.81％,x2=35.055,P=0.000);超声引导下穿刺成功率高于盲穿(99.80％比96.34％,x2=29.905,P=0.000).术中并发症发生率为0.80％(16/2 007),包括气胸9例、血胸2例、淋巴瘘1例、皮下出血4例.术后并发症发生率为8.86％(178/2 007),其中早期并发症20例(0.10％),包括港穴血肿7例、导管移位1例、静脉血栓4例、港周感染3例、纤维蛋白鞘形成5例;远期并发症158例(7.87％),包括导管锁部断裂2例、夹壁综合征6例、导管移位1例、导管相关感染65例、部分血栓形成16例、导管壁纤维蛋白鞘形成51例、封管前液体外渗3例、注射座翻转3例、皮肤排异导致港外露11例.并发症导致非正常取港27例(1.34％),其中术后早期并发症导致的被迫取港率较术后远期并发症高(x2=8.053,P=0.011).结论完全植入式静脉输液港在超声引导下、选择右颈内静脉穿刺置管成功率高.其术中和术后并发症很低,是肿瘤患者和需要长期静脉营养患者的良好静脉通道.
목적 탐토완전식입식정맥수액항천자치관방식적성공솔、병발증발생적원인급대책.방법 회고성분석2008년12월지2013년3월2 007례접수정맥천자치관적완전식입식정맥수액항수술환자적림상자료,포괄2 005례악성종류환자화2례량성질병환자,남성38례,녀성1 969례;년령21～ 85세,평균년령47.6세.대천자방식、성공솔,술중、술후병발증이급상관처리조시화치료효과진행분층분석.결과 환자대항시간위9～1 243 d,평균(242±12)d.우경내정맥맹천성공솔최고(99.76％),좌쇄골하정맥맹천성공솔최저(81.81％,x2=35.055,P=0.000);초성인도하천자성공솔고우맹천(99.80％비96.34％,x2=29.905,P=0.000).술중병발증발생솔위0.80％(16/2 007),포괄기흉9례、혈흉2례、림파루1례、피하출혈4례.술후병발증발생솔위8.86％(178/2 007),기중조기병발증20례(0.10％),포괄항혈혈종7례、도관이위1례、정맥혈전4례、항주감염3례、섬유단백초형성5례;원기병발증158례(7.87％),포괄도관쇄부단렬2례、협벽종합정6례、도관이위1례、도관상관감염65례、부분혈전형성16례、도관벽섬유단백초형성51례、봉관전액체외삼3례、주사좌번전3례、피부배이도치항외로11례.병발증도치비정상취항27례(1.34％),기중술후조기병발증도치적피박취항솔교술후원기병발증고(x2=8.053,P=0.011).결론 완전식입식정맥수액항재초성인도하、선택우경내정맥천자치관성공솔고.기술중화술후병발증흔저,시종류환자화수요장기정맥영양환자적량호정맥통도.
Objective To summarize the disposal methods and the reasons of complications in operation of totally implantable central venous port (TICVP).Methods A total of 2 007 patients were enrolled in this observational,single-center study between December 2008 and March 2013.TICVP implantation was performed with one small skin incision and subcutaneous puncture of subclavian or jugular vein.Patient's profiles,indications of port system,early and delayed complications,and disposal methods were evaluated.There were 38 male and 1 969 female patients,aged from 21 to 85 years,with a mean of 47.6 years.Results The mean duration of the TICVP system was (242 ± 12) days,ranging from 9 to 1 243 days.The achievement rate of puncture in the right jugular vein (99.76％) was the highest.Sonographic approach using the internal jugular vein were better than the external landmark-guided technique (99.80％ vs.96.34％,x2 =29.905,P =0.000).The rate of immediate complication was 0.80％,which included pneumothorax,hemothorax,lymphatic fistula and thrombosis.Early complications rate was 0.10％,which included pocket hematoma,catheter migration,venous thrombosis,port pocket infection,fibrin sheath formation.Late complications rate was 7.87％,which included catheter fracture,pinch-off syndrome,catheter-related bloodstream infection,fibrin sheath formation,catheter migration,extravasation,port inversion and port reveal.The rate of removal due to complications was 1.34％ (27/2 007),and the early complication was higher (x2 =8.053,P =0.011).Conclusions The low incidence of complications suggests that TICVP is safe and reliable for long term intermittent venous access.The results support the use of TICVP in the oncology patients and patients requiring long-term intravenous therapy.