Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France.
Eur J Surg Oncol. 2011 Oct;37(10):913-8. doi: 10.1016/j.ejso.2011.06.016. Epub 2011 Aug 9.
Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity.
A total of 815 consecutive cancer patients (median age: 56.2 years [0.8-85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier.
The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2-12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0-3 days, 17.1% when it was 4-7 days and 12.1% when it exceeded 7 days (p < 0.01; Chi(2) test). The median interval was 6 days (0-53) and 8 days (0-135), respectively, in patients with and without complications (p < 0.001).
To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable.
全植入式静脉通路端口系统（TIVAPs）在肿瘤学中被广泛应用，但并发症频繁，有时需要移除设备，从而导致化疗延迟。本研究旨在探讨发病率的可能危险因素。
2006 年 5 月 2 日至 2007 年 4 月 30 日，共纳入 815 例连续癌症患者（中位年龄：56.2 岁[0.8-85.2]；522 例女性）进行这项观察性、单中心研究。TIVAPs 植入涉及头静脉或颈外静脉。除非设备提前移除，否则患者将在一年内接受随访。
总发病率为 16.1%（131/815）。55 例患者因并发症需要移除设备，平均在植入后 3.7 个月[0.2-12.0]。这些并发症包括 TIVAP 相关感染（19 例）、端口脱出（14 例）、导管迁移（6 例）、静脉血栓形成（5 例）、机械问题（3 例）、皮肤疾病（2 例）、疼痛（2 例）、药物外渗（2 例）、与 TIVAP 无关的感染（1 例）和炎症（1 例）。研究期间无患者死亡。最能预测并发症的因素是 TIVAP 插入和首次使用之间的间隔时间，范围为 0 至 135 天（中位数：8.0 天）。当间隔时间为 0-3 天时，发病率为 24.4%；当间隔时间为 4-7 天时，发病率为 17.1%；当间隔时间超过 7 天时，发病率为 12.1%（p<0.01；卡方检验）。有并发症和无并发症患者的中位间隔时间分别为 6 天（0-53）和 8 天（0-135）（p<0.001）。
为了减少并发症，TIVAP 首次使用前的间隔时间至少 8 天可能是明智的。
