Biffi R, Pozzi S, Agazzi A, Pace U, Floridi A, Cenciarelli S, Peveri V, Cocquio A, Andreoni B, Martinelli G
Division of General Surgery, European Institute of Oncology, Milan, Italy.
Ann Oncol. 2004 Feb;15(2):296-300. doi: 10.1093/annonc/mdh049.
The complication rate of central venous totally implantable access ports (TIAP), used for high-dose chemotherapy with autologous stem cell transplantation support, has not been fully investigated to date, due to the almost exclusive use of externalised, tunnelled devices in this clinical setting.
During a 66-month period (from 1 January 1997 to 30 June 2002), 376 patients suffering from breast cancer, ovarian cancer, lymphoma or multiple myeloma were treated with high-dose chemotherapy and autologous stem cell transplantation at the European Institute of Oncology (Milan, Italy). A single type of port was used, constructed from titanium and silicone rubber, connected to a 7.8 F polyurethane catheter (Port-A-Cath; SIMS Deltec, Inc., St Paul, MN, USA) inserted into the subclavian vein. They were followed prospectively for device-related complications until the device was removed, the patient died or the study was closed (30 June 2002).
No TIAP-related deaths were observed in this series. Seven pneumothoraxes (1.8%) occurred as a complication of TIAP placement, one patient only (0.2%) requiring a tube thoracostomy. Port pocket infection occurred twice in this series (0.53%, 0.01 episodes/1000 days of use), whereas three patients suffered from port-related bacteraemia (0.8%, 0.016/1000 days of use). Infections were successfully treated with antibiotics; all three cases had the ports removed at programme completion. Four cases of deep vein thrombosis were detected (1.06%, 0.022/1000 days of use); low molecular weight heparin was given, followed by oral anticoagulants. Finally, one case of extravasation occurred (0.26%, 0.005/1000 days of use), requiring port removal and local medical therapy.
The use of TIAPs has resulted in a safe and effective option for high-dose chemotherapy deliverance and stem cell transplantation, in spite of inducing severe neutropenia and increasing the risk of sepsis in this category of oncology patient.
由于在这种临床环境中几乎完全使用外置的隧道式装置，用于支持自体干细胞移植的高剂量化疗的中心静脉全植入式输液港（TIAP）的并发症发生率迄今尚未得到充分研究。
在66个月期间（从1997年1月1日至2002年6月30日），376例患有乳腺癌、卵巢癌、淋巴瘤或多发性骨髓瘤的患者在欧洲肿瘤研究所（意大利米兰）接受了高剂量化疗和自体干细胞移植。使用了单一类型的输液港，由钛和硅橡胶制成，连接到一根插入锁骨下静脉的7.8F聚氨酯导管（Port-A-Cath；SIMS Deltec公司，美国明尼苏达州圣保罗）。对患者进行前瞻性随访，观察与装置相关的并发症，直至装置移除、患者死亡或研究结束（2002年6月30日）。
本系列中未观察到与TIAP相关的死亡病例。7例气胸（1.8%）作为TIAP置入的并发症发生，仅1例患者（0.2%）需要进行胸腔闭式引流术。本系列中发生2次输液港囊袋感染（0.53%，0.01次/1000使用日），而3例患者发生与输液港相关的菌血症（0.8%，0.016/1000使用日）。感染通过抗生素成功治疗；所有3例在疗程结束时均移除了输液港。检测到4例深静脉血栓形成（1.06%，0.022/1000使用日）；给予低分子量肝素，随后口服抗凝剂。最后，发生1例渗漏（0.26%，0.005/1000使用日），需要移除输液港并进行局部药物治疗。
尽管TIAP的使用会导致严重的中性粒细胞减少并增加这类肿瘤患者发生败血症的风险，但它已成为高剂量化疗给药和干细胞移植的一种安全有效的选择。
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