Wilson Guineva J P, van Noesel M M, Hop W C J, van de Ven C
Department of General Surgery, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
J Pediatr Surg. 2006 Oct;41(10):1694-8. doi: 10.1016/j.jpedsurg.2006.05.065.
Totally implantable venous access devices (TIVAD) facilitate repeat intravenous therapy for children. Many children recover and the device may be removed. Although removal should be a simple procedure via a single incision, in our experience, this has not been the case.
Two hundred consecutive cases of removal of TIVAD from September 2000 to January 2004 at Sophia Children's Hospital, Rotterdam, were reviewed.
Average patient age was 5.9 years. The commonest indication for placement was administration of chemotherapy (88%); commonest indication for removal was remission of disease (70%). The median duration in situ of the catheter was 29 months (range, 0.4-91 months). Complications with removal of the polyurethane catheter of the TIVAD were experienced in 16% of cases. To enable removal, a second incision was required in 28 patients, venotomy in 5; the catheter could not be removed in 3. For all complicated removals the catheter had been in situ for longer than 20 months.
Long-term implantation of TIVAD with polyurethane catheter appears unsuitable owing to a high incidence of complication at time of removal.
完全植入式静脉通路装置（TIVAD）便于对儿童进行重复静脉治疗。许多儿童康复后，该装置可能会被移除。尽管通过单一切口移除装置应该是一个简单的操作，但根据我们的经验，情况并非如此。
回顾了2000年9月至2004年1月在鹿特丹索菲亚儿童医院连续200例TIVAD移除病例。
患者平均年龄为5.9岁。放置装置最常见的指征是化疗给药（88%）；移除装置最常见的指征是疾病缓解（70%）。导管在位的中位时间为29个月（范围0.4 - 91个月）。16%的病例在移除TIVAD的聚氨酯导管时出现并发症。为了完成移除，28例患者需要做第二个切口，5例需要进行静脉切开术；3例无法移除导管。所有复杂的移除情况中，导管在位时间均超过20个月。
由于移除时并发症发生率较高，长期植入带有聚氨酯导管的TIVAD似乎不合适。
