Conter C, Carausu L, Martin E, Rubie H, Castex M-P, Marec-Berard P
Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
Arch Pediatr. 2006 Mar;13(3):256-61. doi: 10.1016/j.arcped.2005.12.010. Epub 2006 Feb 15.
The feasibility and complication rate of central venous totally implantable access ports (TIAP), used for delivering high-dose chemotherapy (HDC) with autologous stem cell transplantation, have not been fully investigated to date, due to the almost exclusive use of external catheters (EC) in this clinical setting.
We retrospectively studied infectious and mechanical complications of 45 TIAP and 19 EC, in 64 children receiving HDC and autologous stem cell transplantation at the Centre Leon-Berard (Lyon) or at the oncology unit of Toulouse children hospital between January 1999 and December 2003.
From the beginning of intensification to 60 days after bone marrow transplantation, 7 catheter-related bloodstream infections (3/19 EC or 15.8% corresponding to 2.69 infections for 1000 days of observation; 4/45 TIAP or 8.9% corresponding to 1.38 infections for 1000 days of observation) and 2 local infections (1/45 TIAP; 1/19 EC) were reported. Seven cases of reversible obstruction (6/7 with TIAP) and no deep venous thrombosis were detected. In 7 cases, another venous access was required either for accidental removal (2 EC), catheter infection (2 TIAP), or admission to intensive care (2 TIAP, 1 EC). TIAP complication rate does not seem to be influenced by factors such as low weight, massive blood product transfusion or prolonged parenteral nutrition. In 8 children, TIAP were used for collection of hematopoietic progenitor cells.
The use of TIAPs appears as a safe and effective option for HDC. We found more mechanical complications but less infectious complications with TIAP than with EC. Nevertheless, results need to be validated prospectively in a larger study cohort.
迄今为止，由于在这种临床环境中几乎完全使用外部导管（EC），用于自体干细胞移植的高剂量化疗（HDC）的中心静脉完全植入式接入端口（TIAP）的可行性和并发症发生率尚未得到充分研究。
我们回顾性研究了1999年1月至2003年12月期间在里昂贝拉尔中心（里昂）或图卢兹儿童医院肿瘤科接受HDC和自体干细胞移植的64名儿童中45个TIAP和19个EC的感染和机械并发症。
从强化治疗开始到骨髓移植后60天，报告了7例导管相关血流感染（19个EC中有3例，即15.8%，相当于每1000天观察有2.69例感染；45个TIAP中有4例，即8.9%，相当于每1000天观察有1.38例感染）和2例局部感染（45个TIAP中有1例；19个EC中有1例）。检测到7例可逆性梗阻（7例中有6例使用TIAP），未发现深静脉血栓形成。在7例病例中，由于意外拔除（2个EC）、导管感染（2个TIAP）或入住重症监护病房（2个TIAP，1个EC），需要另一个静脉通路。TIAP并发症发生率似乎不受低体重、大量输血或长期肠外营养等因素影响。在8名儿童中，TIAP用于采集造血祖细胞。
TIAP的使用似乎是HDC的一种安全有效的选择。我们发现TIAP的机械并发症比EC多，但感染并发症比EC少。然而，结果需要在更大的研究队列中进行前瞻性验证。
