Estes Jacob M, Rocconi Rodney, Straughn J Michael, Bhoola Snehal, Leath Charles A, Alvarez Ronald D, Kilgore Larry C, Huh Warner K
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
Gynecol Oncol. 2003 Dec;91(3):591-5. doi: 10.1016/j.ygyno.2003.08.015.
The purpose of this study was to evaluate the complication rates associated with indwelling venous access devices in patients with gynecologic malignancies.
Following IRB approval, a computerized database identified women that had indwelling access devices placed for chemotherapy from March 1999 to June 2001. A retrospective chart review identified 116 venous access devices that were placed in 104 patients. All devices were silicone and had a closed tip design with a three-position valve. Data were collected on patient demographics, clinicopathologic features, type of venous device, and complications. The chi(2) test was used for statistical analysis.
Of the 104 patients, 79 had ovarian cancer, 11 had uterine cancer, 10 had cervical cancer, 2 had fallopian tube cancer, and 2 had vaginal cancer. The median age was 61 years. There were a total of 116 venous devices placed: 65 external catheters (EC) and 51 subcutaneous ports (SP). Seventy-nine percent of the patients were administered low-dose coumadin (1 mg/day) for catheter clot prophylaxis. There were three operative complications in the EC group and two in the SP group (P = NS). The most common postoperative complications were infection and thrombosis. Nineteen patients in the EC group experienced a catheter-related infection versus 5 in the SP group (P = 0.025). In the EC group, there were 11 cases of site infection and 8 cases of line sepsis. In contrast, there were 3 cases of exit site infection and 2 cases of line sepsis in the SP group. Deep vein thrombosis occurred in 5 patients with EC and 3 patients with SP (P = NS). Twenty-seven patients with EC had the device removed for catheter-related complications versus 2 patients with SP (P = 0.001). Six patients inadvertently removed their EC.
There is a significantly higher postoperative complication rate in gynecologic oncology patients with external catheters versus subcutaneous ports. Infection and catheter-related malfunction are more common in patients with external catheters. We recommend the use of subcutaneous ports in the majority of patients with gynecologic malignancies.
本研究旨在评估妇科恶性肿瘤患者留置静脉通路装置的并发症发生率。
经机构审查委员会（IRB）批准后，利用计算机数据库识别出1999年3月至2001年6月期间因化疗而留置通路装置的女性患者。通过回顾性病历审查，确定了104例患者体内留置的116个静脉通路装置。所有装置均为硅胶材质，采用带有三位阀的封闭尖端设计。收集了患者人口统计学资料、临床病理特征、静脉装置类型及并发症等数据。采用卡方检验进行统计分析。
104例患者中，79例患有卵巢癌，11例患有子宫癌，10例患有宫颈癌，2例患有输卵管癌，2例患有阴道癌。中位年龄为61岁。共放置了116个静脉装置：65个外置导管（EC）和51个皮下埋植式给药装置（SP）。79%的患者接受低剂量华法林（1毫克/天）治疗以预防导管血栓形成。EC组有3例手术并发症，SP组有2例（P = 无统计学意义）。最常见的术后并发症是感染和血栓形成。EC组有19例患者发生与导管相关的感染，而SP组有5例（P = 0.025）。在EC组，有11例局部感染和8例导管败血症。相比之下，SP组有3例出口部位感染和2例导管败血症。5例使用EC的患者和3例使用SP的患者发生深静脉血栓形成（P = 无统计学意义）。27例使用EC的患者因与导管相关的并发症而拔除装置，而使用SP的患者有2例（P = 0.001）。6例患者意外拔除了他们的EC。
与皮下埋植式给药装置相比，妇科肿瘤患者使用外置导管的术后并发症发生率显著更高。感染和与导管相关的故障在使用外置导管的患者中更为常见。我们建议大多数妇科恶性肿瘤患者使用皮下埋植式给药装置。
