Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 63, Chicago, IL 60611, United States.
J Pediatr Surg. 2022 Mar;57(3):450-453. doi: 10.1016/j.jpedsurg.2021.02.055. Epub 2021 Feb 26.
Purpose While central venous port placement is common, there remains variation in placement technique and rates of technical complications. The aim of this study was to assess variability in techniques and identify predictors of complications for children undergoing port placement. Methods We retrospectively reviewed all 331 patients who underwent venous port placement at a single tertiary children's hospital from May 2018 to June 2020. The primary outcome was early revision or replacement (R/R) for complications occurring within 30 days. Secondary outcomes included radiation exposure and rate of intraoperative conversion to a secondary site. Results The median age was 7 years (Interquartile Range 3-13 years) and the most common diagnoses were leukemia (30.2%), solid tumors (27.8%), and brain tumors (16.9%). Initial approach for port placement was ultrasound-guided internal jugular (IJV) in 255 (147 by surgery and 108 by interventional radiology [IR]) and landmark subclavian vein (SCV) in 76 (all by surgery). Early R/R occurred in 5.1%, including 9.0% of patients with leukemia but 1.1% with solid tumors. Individual proceduralist volume ranged from 2 to 98 cases and was inversely correlated with early R/R (r = -0.12, p = 0.30). In univariate analysis, ports placed by IR had an increased rate of early R/R (9.3%, n = 10) compared to those placed by surgery (3.2%, n = 7, p = 0.036) but this was not significant in multivariable regression controlling for diagnosis and age (Hazard Ratio 2.04; p = 0.19). Mean fluoroscopy time was significantly longer for ports placed by IR (59.9 s) compared to those placed by surgery (15.1 s, p < 0.001). Initial SCV access was associated with an increased (14.5 vs 0.4%) rate of conversion to a secondary site. Conclusions Though venous port placement is a largely safe procedure in children, a substantial minority of patients, particularly those with leukemia, require early R/R. Proceduralist volume and training may influence early R/R, fluoroscopy exposure, and anatomic site preferences.
虽然中心静脉置管术很常见，但在置管技术和技术并发症发生率方面仍存在差异。本研究旨在评估技术差异，并确定接受置管术的儿童发生并发症的预测因素。
我们回顾性分析了 2018 年 5 月至 2020 年 6 月在一家三级儿童医院接受静脉置管术的 331 例患者的资料。主要结局是 30 天内因并发症而进行早期翻修或更换（R/R）。次要结局包括放射暴露和术中转换至第二部位的发生率。
中位年龄为 7 岁（四分位距 3-13 岁），最常见的诊断为白血病（30.2%）、实体瘤（27.8%）和脑肿瘤（16.9%）。初始置管途径为超声引导下颈内静脉（IJV）入路 255 例（手术 147 例，介入放射学 108 例）和锁骨下静脉（SCV）入路 76 例（均为手术）。早期 R/R 发生率为 5.1%，其中白血病患者为 9.0%，实体瘤患者为 1.1%。个别术者的手术量从 2 例到 98 例不等，与早期 R/R 呈负相关（r=-0.12，p=0.30）。单因素分析显示，介入放射学组的早期 R/R 发生率（9.3%，n=10）高于手术组（3.2%，n=7，p=0.036），但在多变量回归分析中，控制诊断和年龄因素后无统计学意义（风险比 2.04，p=0.19）。与手术组相比，介入放射学组的透视时间明显更长（59.9 秒 vs 15.1 秒，p<0.001）。初始 SCV 入路与较高的（14.5% vs 0.4%）第二部位转换率相关。
尽管儿童静脉置管术是一种相对安全的手术，但仍有相当一部分患者，特别是白血病患者，需要早期 R/R。术者的手术量和培训可能影响早期 R/R、透视暴露和解剖部位选择。
