Dastouri Darius, McSweeney William T, Leaning Matthew, Hendahewa Rasika
General Surgery, Caboolture Hospital, Brisbane, AUS.
Cureus. 2022 Mar 17;14(3):e23244. doi: 10.7759/cureus.23244. eCollection 2022 Mar.
Background The need for chemotherapy treatment is increasing with the growing incidence of cancer worldwide. The insertion of totally implantable venous access devices (TIVADs) is commonly performed by surgeons and radiologists, but the procedures are not without complications. The primary outcome of this review outlines TIVAD insertion success and complication rates between general surgeons and radiologists. The secondary goal of this study is to help identify areas for improvement and consideration when performing TIVAD insertion. Methodology This was a descriptive, three-year, retrospective multicentre study of oncological patients who underwent TIVAD insertion by either general surgeons or radiologists at two peripheral Brisbane hospitals. Results Surgeons performed 61 percutaneous subclavian vein cannulations, 29 ultrasound-guided internal jugular veins, and seven open cephalic veins cut-down TIVAD insertions (n=97). Overall surgical success was 81.4%, with the internal jugular (89.7%) having the highest success rate followed by the open cut-down (85.7) and subclavian approaches (77.0%). The overall surgical complication rate was 16.4%, with five pneumothorax, five port malfunctions, three haemorrhages, two infections, one thrombus, and one mediastinal injury. Each pneumothorax was associated with subclavian cannulation attempts. Two haemorrhages were associated with both open cephalic and subclavian attempts. Radiologists performed 248 ultrasound-guided internal jugular vein TIVAD insertions (n=248) with 247 successful first attempts (99.5%). Within the radiology group, there was an overall complication rate of 15.3% with 22 infections, 14 port malfunctions, one haemorrhage, and 1 mediastinal injury. Conclusion Ultrasound-guided internal jugular vein TIVAD insertion had the highest first attempt success rate in both the surgical and radiology groups.
背景 随着全球癌症发病率的上升，化疗治疗的需求也在增加。完全植入式静脉通路装置（TIVADs）的植入通常由外科医生和放射科医生进行，但这些操作并非没有并发症。本综述的主要结果概述了普通外科医生和放射科医生在TIVAD植入方面的成功率和并发症发生率。本研究的次要目标是帮助确定在进行TIVAD植入时需要改进和考虑的领域。方法 这是一项为期三年的描述性回顾性多中心研究，研究对象为在布里斯班两家外围医院接受普通外科医生或放射科医生进行TIVAD植入的肿瘤患者。结果 外科医生进行了61次经皮锁骨下静脉插管、29次超声引导下颈内静脉插管和7次开放式头静脉切开TIVAD植入（n = 97）。总体手术成功率为81.4%，其中颈内静脉（89.7%）成功率最高，其次是开放式切开（85.7%）和锁骨下途径（77.0%）。总体手术并发症发生率为16.4%，包括5例气胸、5例端口故障、3例出血、2例感染、1例血栓和1例纵隔损伤。每例气胸均与锁骨下插管尝试有关。2例出血与开放式头静脉和锁骨下尝试均有关。放射科医生进行了248次超声引导下颈内静脉TIVAD植入（n = 248），首次尝试成功247次（99.5%）。在放射科组中，总体并发症发生率为15.3%，包括22例感染、14例端口故障、1例出血和1例纵隔损伤。结论 在外科和放射科组中，超声引导下颈内静脉TIVAD植入的首次尝试成功率最高。
