Kim Dong Hyun, Ryu Dong Yeon, Jung Hyuk Jae, Lee Sang Su
Department of Surgery, Vascular and Endovascular Division, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam 50612, Republic of Korea.
Exp Ther Med. 2019 Mar;17(3):2013-2018. doi: 10.3892/etm.2019.7185. Epub 2019 Jan 18.
The aim of the present study was to describe the procedure of totally implantable central venous port system (TICVPS) insertion performed at our center and investigate associated complications. The study retrospectively evaluated 827 patients who underwent a single-type TICVPS insertion from January 2013 to July 2015. The length of the procedure, long-term device function, angle (chamber-to-tip) and complications of TICVPS, including infection, skin erosion, occlusion, malposition and thrombosis, were analyzed from the patients' medical records. A total of 843 TICVPS insertions were performed in 827 patients. The TICVPS implantation was successful in all cases (100%). A total of 34 cases (4.0%) with complications were recorded. Complications at the chamber insertion site occurred in 11 patients (1.3%), including 5 infection (0.6%) and 6 erosion cases (0.7%). All patients with chamber insertion site infection were treated by administration of antibiotics and dressing. Of the patients in which chamber insertion site erosion occurred, 2 were subjected to TICVPS removal and reinsertion and 4 were treated with debridement, irrigation and resuture. The most common type of complication was catheter-associated (2.3%; n=19). Among these cases, 7 had catheter-associated infection (0.8%), 8 had catheter migration (1.0%) confirmed by chest radiography, 4 had catheter-associated thrombosis (0.5%) and 2 had chamber malposition (0.3%). The present retrospective study on TICVPS, which used a relatively large cohort, demonstrated a low complication rate (4.0%) compared with that reported in previous studies (5-20%). A well-designed procedure, experienced vascular surgeons, an aseptic operating room environment, ultrasound-guided puncture, a wide angle (chamber-to-tip) and the use of fluoroscopy with contrast agent may reduce the complication rate of TICVPS insertion.
本研究的目的是描述在我们中心进行的完全植入式中心静脉导管系统（TICVPS）插入操作的过程，并调查相关并发症。该研究回顾性评估了2013年1月至2015年7月期间接受单一类型TICVPS插入的827例患者。从患者的病历中分析了操作时间、长期装置功能、TICVPS的角度（腔室至尖端）以及并发症，包括感染、皮肤糜烂、阻塞、位置异常和血栓形成。827例患者共进行了843次TICVPS插入。所有病例（100%）的TICVPS植入均成功。共记录到34例（4.0%）并发症。腔室插入部位的并发症发生在11例患者（1.3%）中，包括5例感染（0.6%）和6例糜烂病例（0.7%）。所有腔室插入部位感染的患者均通过使用抗生素和换药进行治疗。在发生腔室插入部位糜烂的患者中，2例接受了TICVPS取出并重新插入，4例接受了清创、冲洗和重新缝合治疗。最常见的并发症类型是导管相关并发症（2.3%；n = 19）。在这些病例中，7例有导管相关感染（0.8%），8例经胸部X线证实有导管移位（1.0%），4例有导管相关血栓形成（0.5%），2例有腔室位置异常（0.3%）。本项关于TICVPS的回顾性研究使用了相对较大的队列，与先前研究报道的并发症发生率（5 - 20%）相比，显示出较低的并发症发生率（4.0%）。精心设计的操作程序、经验丰富 的血管外科医生、无菌的手术室环境、超声引导穿刺、较大的角度（腔室至尖端）以及使用含造影剂的荧光透视检查可能会降低TICVPS插入的并发症发生率。
