Azaïs Henri, Bresson Lucie, Bassil Alfred, Katdare Ninad, Merlot Benjamin, Houpeau Jean-Louis, El Bedoui Sophie, Meurant Jean-Pierre, Tresch Emmanuelle, Narducci Fabrice
1 Department of Gynecologic Oncology, Centre Oscar Lambret, Lille Cedex - France.
J Vasc Access. 2015 Jan-Feb;16(1):31-7. doi: 10.5301/jva.5000316. Epub 2014 Oct 16.
Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL).
Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively.
Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft.
CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.
全植入式静脉输液港系统（TIVAPS）是化疗有效给药中广泛使用的重要工具。化疗药物外渗（CDE）可能会产生严重后果并延误治疗。本研究的目的是阐明CDE的处理方法并展示早期手术冲洗（ESL）的有效性。
回顾性分析2004年1月至2013年4月间在法国里尔癌症中心植入TIVAPS并发生CDE的患者的病历。
分析了30例患者和33起事件。涉及的药物有发泡剂（51.5%）、刺激性药物（45.5%）和非发泡剂（3%）。27例与休伯针位置不当有关。97%的病例进行了手术，其中87.5%进行了ESL，后者中有53.1%需要取出TIVAPS。6例患者因不良后果（严重病例）需要二次干预。6例严重病例中有4例涉及发泡剂，另外2例涉及奥沙利铂。80%的病例外渗量超过50毫升。只有1例患者需要植皮。
CDE应在专科中心进行处理。ESL使用简单且易于普及的技术，使化疗药物与组织的接触有限。与不良后果相关的两个主要因素似乎是所涉药物的性质（发泡剂）和外渗量（超过50毫升），这会导致更差的结果。奥沙利铂应被视为发泡剂。
