Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore.
J Vasc Surg Venous Lymphat Disord. 2022 Sep;10(5):1184-1191.e8. doi: 10.1016/j.jvsv.2022.03.007. Epub 2022 Mar 30.
Ensuring reliable central venous access with the fewest complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life, and cost-effectiveness of different types of central venous access devices (CVADs) for patients receiving chemotherapy.
The PubMed, EMBASE, and Cochrane databases were searched from inception to August 20, 2021 for randomized controlled trials comparing the various CVADs (ie, nontunneled central venous catheters [CVCs], peripherally inserted CVCs [PICCs], totally implantable venous access ports [TIVAPs], and tunneled CVCs).
A total of 11 eligible randomized controlled trials of 2585 patients were identified. TIVAPs were associated with a lower odds of overall complications, device removal due to complications, and thrombotic and mechanical complications compared with PICCs (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.69; OR, 0.49; 95% CI 0.26-0.93; OR, 0.37; 95% CI, 0.23-0.62; and OR, 0.35; 95% CI, 0.13-0.95, respectively). Tunneled CVCs were associated with a higher odds of overall complications, device removal due to complications, and infective complications compared with TIVAPs (OR, 1.68; 95% CI, 1.30-2.17; OR, 2.52; 95% CI, 1.34-4.73; and OR, 2.11; 95% CI, 1.14-3.90, respectively). The ranking probability using the surface under the cumulative ranking curve values indicated that TIVAPs had the lowest probability of overall complications, removal due to complications, and thrombotic complications.
TIVAPs were found to be superior in terms of complications and quality of life compared with other CVADs, without compromising cost-effectiveness, and should be considered the standard of care for patients receiving chemotherapy.
对于接受化疗的癌症患者，确保可靠的中央静脉通路并将并发症降至最低至关重要。本系统评价和网络荟萃分析旨在比较不同类型的中央静脉通路装置（CVAD）在接受化疗的患者中的安全性、生活质量和成本效益。
从 1997 年 1 月至 2021 年 8 月 20 日，检索 PubMed、EMBASE 和 Cochrane 数据库，以比较各种 CVAD（即无隧道中央静脉导管[CVC]、外周插入的 CVC[PICC]、完全植入式静脉接入端口[TIVAP]和隧道式 CVC）的随机对照试验。
共纳入 11 项 2585 例患者的随机对照试验。与 PICC 相比，TIVAP 发生总体并发症、因并发症而拔除装置、血栓形成和机械性并发症的可能性较低（比值比[OR]，0.54；95%置信区间[CI]，0.43-0.69；OR，0.49；95%CI，0.26-0.93；OR，0.37；95%CI，0.23-0.62；OR，0.35；95%CI，0.13-0.95）。与 TIVAP 相比，隧道式 CVC 发生总体并发症、因并发症而拔除装置和感染性并发症的可能性较高（OR，1.68；95%CI，1.30-2.17；OR，2.52；95%CI，1.34-4.73；OR，2.11；95%CI，1.14-3.90）。使用累积排序曲线下面积值的表面下概率表明，TIVAP 发生总体并发症、因并发症而拔除装置和血栓形成并发症的概率最低。
与其他 CVAD 相比，TIVAP 在并发症和生活质量方面表现更好，且不会影响成本效益，应被视为接受化疗患者的护理标准。
