Ragusa M, Alberti D, Argento R, Avenia N, Bartolucci R, Esposito S, Ferilli F, Marini C
Clinica Chirurgica Generale e Toracica, Università degli Studi, Perugia.
Minerva Chir. 2000 Mar;55(3):139-46.
A safe and dependable venous access is mandatory in order to perform cancer chemotherapy and monitor blood values in the neoplastic patient. Prolonged infusions of medications with sclerosing action may damage the vessel wall, inducing chemical thrombophlebitis. Furthermore, extravasation of necrotizing compounds may be a danger to the patient. The application of totally implantable venous access systems (VAS) started in 1982, in the United States of America, where at present 500,000 devices are implanted annually. In Italy such method has been introduced in a later period, with a constantly growing trend. VAS devices have evolved since their first presentation, and so have application techniques: the original surgical route has been supported by the percutaneous one, considered most appropriate by several Centers. In this study, personal experience concerning application of VAS in cancer patients is presented.
From July 1994 to February 1998, at the General Thoracic Surgery Dept. of the University of Perugia, 198 VAS have been implanted in 195 patients. During the first period all the systems have been applied by surgical cutdown of the cephalic vein (150 cases). In the last 12 month the percutaneous technique for vein puncture has been adopted in 48 patients.
Immediate and late complications have occurred: among the former, pneumothorax, hematoma, malposition; among the latter, infection, subclavian vein thrombosis, catheter rupture. The results are analysed after an extensive review of the international literature; pros and cons of the different implantation techniques and the technical aspects useful for preventing complications are underlined.
为了对肿瘤患者进行癌症化疗和监测血液指标，安全可靠的静脉通路至关重要。长时间输注具有硬化作用的药物可能会损伤血管壁，引发化学性血栓性静脉炎。此外，坏死性化合物的外渗可能对患者构成危险。完全植入式静脉通路系统（VAS）于1982年在美国开始应用，目前每年植入50万台设备。在意大利，这种方法引入较晚，但呈持续增长趋势。自首次推出以来，VAS设备不断发展，应用技术也是如此：最初的手术途径得到了经皮途径的支持，几个中心认为经皮途径最为合适。本研究介绍了在癌症患者中应用VAS的个人经验。
1994年7月至1998年2月，在佩鲁贾大学普通胸外科，195例患者植入了198个VAS。在第一阶段，所有系统均通过切开头静脉进行植入（150例）。在最后12个月，48例患者采用了经皮静脉穿刺技术。
出现了即刻和晚期并发症：前者包括气胸、血肿、位置不当；后者包括感染、锁骨下静脉血栓形成、导管破裂。在广泛查阅国际文献后对结果进行了分析；强调了不同植入技术的优缺点以及预防并发症有用的技术要点。
