Cortés-Flores Ana Olivia, Morgan-Villela Gilberto, Juárez-Uzeta Ernesto Alejandro, Fuentes-Orozco Clotilde, Jiménez-Tornero Jorge, González-Ojeda Alejandro
Oncología Privada Integral ONKOS, Guadalajara, Jalisco, México.
Cir Cir. 2012 Sep-Oct;80(5):429-34.
Use of totally implantable central venous access ports in cancer patients is a common practice for chemotherapy not excluding early and late morbidity.
To report the experience using these devices in a private cancer center.
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.
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.
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.
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.
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。
报告在一家私立癌症中心使用这些装置的经验。
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。
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。
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。
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。