Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
J Pediatr Surg. 2022 Sep;57(9):229-233. doi: 10.1016/j.jpedsurg.2021.08.003. Epub 2021 Aug 8.
We sought to identify clinical features associated with difficult subcutaneous port removals in children.
Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations.
57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5-2.6] versus 0.8 years [IQR 0.5-1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis.
Polyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.
我们旨在确定与儿童皮下置管取出困难相关的临床特征。
本研究前瞻性地跟踪了 2014 年 4 月至 2017 年 9 月期间在我院植入的置管情况，以确定其取出困难的病例。将取出困难的置管（卡滞；病例）与生物性别和年龄相匹配的 3 倍对照进行病例对照分析。使用逻辑回归确定病例/对照状态与临床特征之间的关联，调整生物性别和年龄作为协变量。进行多变量分析以确定独立的关联。
共分析了 57 个卡滞的置管（28 个极端[10 个血管内介入]和 29 个中度）和 171 个对照。卡滞的置管与急性淋巴细胞白血病（ALL）的诊断（86%病例与 22.2%对照；p<0.001）和更长的置管时间（中位数 2.6 年[四分位距（IQR）2.5-2.6]与 0.8 年[IQR 0.5-1.4]；p<0.001）相关。在单变量分析中，与卡滞置管相关的操作和设备特征包括锁骨下入路（71.9%病例与 48.5%对照；p=0.0126）、聚亚安酯与硅胶导管（96.5%病例与 79.9%对照；p=0.001）和取出时导管外观粗糙（92.6%病例与 9.4%对照；p<0.0001）。多变量分析显示，ALL 的诊断和置管时间与卡滞置管相关。
用于治疗急性淋巴细胞白血病两年的聚亚安酯中心静脉导管可能难以取出。这种因素组合需要更广泛地讨论风险、血管内介入的备用情况，并为更长的手术室时间做好安排。
