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[癌症患者的完全植入式中心静脉通路装置。一家私立肿瘤中心的经验]

[Totally implantable central venous access devices in patients with cancer. Experience at a private oncology center].

作者信息

Cortés-Flores Ana Olivia, Morgan-Villela Gilberto, Juárez-Uzeta Ernesto Alejandro, Fuentes-Orozco Clotilde, Jiménez-Tornero Jorge, González-Ojeda Alejandro

机构信息

Oncología Privada Integral ONKOS, Guadalajara, Jalisco, México.

出版信息

Cir Cir. 2012 Sep-Oct;80(5):429-34.

Abstract

BACKGROUND

Use of totally implantable central venous access ports in cancer patients is a common practice for chemotherapy not excluding early and late morbidity.

OBJECTIVE

To report the experience using these devices in a private cancer center.

METHODS

A consecutive series of 156 cases of patients using these devices placed by the same surgical team to enhance chemotherapy. They were evaluated over a period of 44 months. Prevalence of early and late complications and days-risk for patient infection was determined.

RESULTS

In 140 cases (89.8%) patients underwent placement of totally implantable devices by surgical cut down through the external jugular vein. One case was done (0.6%) through the internal jugular, and another one (0.6%) through the cephalic vein (0.6%). In the remaining 13 cases (8.4%) devices were placed by percutaneous puncture of the subclavian vein. In one case it was impossible to place it by any of the two access ways (0.6%). The prevalence of early complications was 3.22% and of late complications 1.93%. The average days-risk for the development of infection was 473.8/patient. One case had fracture of the catheter during follow up. There was no mortality.

DISCUSSION

Overall complication rate was 5.15%, similar to that reported by reference centers, without infection during follow-up. Access through the external jugular vein facilitates correct positioning of the catheter and has fewer complications.

CONCLUSIONS

The combination of a trained surgical team and careful monitoring reduces morbidity and prevents infections. Access through the external jugular is recommended for its accessibility and low morbidity.

摘要

背景

在癌症患者中使用全植入式中心静脉通路端口是化疗的常见做法,且不排除早期和晚期发病情况。

目的

报告在一家私立癌症中心使用这些装置的经验。

方法

连续系列研究156例使用这些装置的患者,由同一手术团队放置以强化化疗。对他们进行了44个月的评估。确定早期和晚期并发症的发生率以及患者感染的日风险。

结果

140例(89.8%)患者通过经颈外静脉手术切开置入全植入式装置。1例(0.6%)通过颈内静脉置入,另1例(0.6%)通过头静脉置入。其余13例(8.4%)通过锁骨下静脉经皮穿刺置入装置。1例无法通过上述两种置入途径中的任何一种进行放置(0.6%)。早期并发症发生率为3.22%,晚期并发症发生率为1.93%。感染发生的平均日风险为473.8/患者。1例在随访期间发生导管断裂。无死亡病例。

讨论

总体并发症发生率为5.15%,与参考中心报告的相似,随访期间无感染发生。经颈外静脉置入便于导管正确定位且并发症较少。

结论

训练有素的手术团队与仔细监测相结合可降低发病率并预防感染。推荐经颈外静脉置入,因其易于操作且发病率低。

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