Hoareau-Gruchet F, Rtail R, Sulaj H, Khirnetkina A, Reyt E, Righini C A
Pôle tête et cou, chirurgie réparatrice, clinique ORL, CHU A.-Michallon, avenue du Maquis-du-Grésivaudan, BP 217, 38043 Grenoble cedex 9, France.
Ann Otolaryngol Chir Cervicofac. 2009 Apr;126(2):43-52. doi: 10.1016/j.aorl.2009.02.005. Epub 2009 Mar 25.
To review the occurrence of early and delayed complications after insertion of a totally implantable venous access port (Tivap) in patients treated with chemotherapy for head and neck squamous cell carcinoma.
Monocentric prospective study (2005-2008) undertaken in a tertiary referral center. In all cases, the inserted Tivap was a Celsite ST301 (Braun) model. The insertion procedure was performed in operating room conditions under local anesthesia using a surgical cut-down method. No antibiotic prophylaxis or long-term anticoagulant medications were administered. Two groups were made between experienced and in-training surgeons. All complications occurring from the date of Tivap insertion to the date of its removal or until the closure of the study were included.
The study comprised of 122 patients including 103 males and 19 females; the patients' mean age was 58.5 years (range, 36-80). Twelve (9.8%) had a tracheotomy or tracheostomy and 41 (33.6%) underwent cervical radiotherapy before Tivap insertion. In 63 cases (51.6%), the procedure was performed by a senior surgeon. The inserted vessel was the cephalic vein (84.4%), the external jugular vein (11.5%) or the internal jugular vein (2.5%). Overall, the total number of days of Tivap implantation was 51,403. Altogether, 11 complications (9%) were listed: two (1.6%) early complications and nine (7.4%) delayed complications. We did not uncover a significant statistical relation between complication onset and experience of the operating surgeon, sex, implanted side, tracheotomy, previous radiotherapy, or number of days of Tivap port.
Our study suggests that: (1) complications are rare provided careful implantation and manipulation methods are followed by health personnel; (2) surgical cephalic cut-down is a very reliable method; and 3) antibiotic prophylaxis or long-term anticoagulant medications are not mandatory.
回顾头颈部鳞状细胞癌化疗患者植入全植入式静脉通路端口（Tivap）后早期和延迟并发症的发生情况。
在一家三级转诊中心进行的单中心前瞻性研究（2005 - 2008年）。所有病例中，植入的Tivap均为Celsite ST301（贝朗）型号。插入 procedure 在手术室条件下采用外科切开法在局部麻醉下进行。未给予抗生素预防或长期抗凝药物。将经验丰富的外科医生和实习外科医生分为两组。纳入从Tivap插入之日至其移除之日或直至研究结束时发生的所有并发症。
该研究包括122例患者，其中男性103例，女性19例；患者平均年龄为58.5岁（范围36 - 80岁）。12例（9.8%）患者进行了气管切开术或气管造口术，41例（33.6%）在Tivap插入前接受了颈部放疗。63例（51.6%）手术由资深外科医生进行。插入的血管为头静脉（84.4%）、颈外静脉（11.5%）或颈内静脉（2.5%）。总体而言，Tivap植入的总天数为51,403天。共列出11例并发症（9%）：2例（1.6%）早期并发症和9例（7.4%）延迟并发症。我们未发现并发症发生与手术医生经验、性别、植入侧、气管切开术、既往放疗或Tivap端口使用天数之间存在显著的统计学关系。
我们的研究表明：（1）只要医护人员遵循仔细的植入和操作方法，并发症很少见；（2）外科头静脉切开术是一种非常可靠的方法；（3）抗生素预防或长期抗凝药物并非必需。
