经颈内静脉植入的全植入式静脉输液港导管自发性断裂及移位——1例病例报告
Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein--a case report.
作者信息
Ko Seung Yeon, Park Sun Cheol, Hwang Jeong Kye, Kim Sang Dong
机构信息
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyong-Gu, Incheon, 403-720, Korea.
出版信息
J Cardiothorac Surg. 2016 Apr 11;11:50. doi: 10.1186/s13019-016-0450-y.
BACKGROUND
The totally implantable venous access ports (TIVAPs) are indicated for patients undergoing chemotherapy, total parenteral nutrition and long-term antibiotic treatment. But, among their complications, the fracture and migration of the catheter of a TIVAP via internal jugular vein represents a very rare but potentially severe condition.
CASE PRESENTATION
A 50-year-old woman indentified with a spontaneous fracture and migration of catheter of a TIVAP via right internal jugular vein after adjuvant chemotherapy for ovary cancer. She had been not evaluated and not managed with the heparin lock flush solution during three months after adjuvant chemotherapy. And then, she complained right neck bulging during saline infusion via a TIVAP and a chest radiography showed the fractured and migrated catheter of a TIVAP in right atrium. So, we emergently removed the catheter fragment by a goose neck snare via right femoral vein. After then, there was no problem.
CONCLUSIONS
If the fractured catheter of a TIVAP is detected, it is desirable to remove a fragment by an endovascular approach if it is possible.
背景
全植入式静脉输液港（TIVAP）适用于接受化疗、全胃肠外营养及长期抗生素治疗的患者。但其并发症中，经颈内静脉置入的TIVAP导管发生断裂和移位是一种非常罕见但可能很严重的情况。
病例介绍
一名50岁女性在卵巢癌辅助化疗后，经右颈内静脉置入的TIVAP导管发生自发性断裂并移位。辅助化疗后的三个月里，她未接受肝素封管液评估及处理。之后，她在经TIVAP输注生理盐水时诉右颈部隆起，胸部X线检查显示TIVAP导管在右心房内发生断裂并移位。于是，我们通过右股静脉用鹅颈圈套器紧急取出了导管碎片。此后，未再出现问题。
结论
如果检测到TIVAP导管断裂，若有可能，可取血管内途径取出碎片。
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