Department of Breast Surgery, Cancer Center, The First Affiliated Hospital of Zhengzhou University, 1 Jianshedong Str, Zhengzhou, 450052, China.
Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
Langenbecks Arch Surg. 2022 Nov;407(7):3123-3132. doi: 10.1007/s00423-022-02573-x. Epub 2022 Jun 3.
Modern oncological treatment in breast cancer patients requires the precise delivery of chemotherapy infusion into the central venous systems without toxicity. TIVAPS is the significant method of chemotherapy delivery although certain internal or external complications associated with their placement. However, the long-term use of TIVAPS is still a concern to minimize the complications such as venous thrombosis syndrome (VTS) and cardiac defects. The aim of this study is to investigate the potential disadvantages that may be avoided by digital radiography (DR)-assisted measurement of catheter depth pertinent to TIVAPS implanted system.
Retrospective analysis related to 5509 TIVAPS recipients of 99% female breast cancer patients and 1% male blood disorder patients registered from April 2013 to November 2017 were included in the study. Patients with TIVAPS catheter tip depth into superior vena cava into upper (group A), middle (group B), and lower (group C) parts were stratified for evaluation during implantation; DR-assisted measurement of TIVAPS was performed to decipher "tip depth of catheter" and determined the relevance of tip depth to complications such as VTS and cardiac defects.
Incidence of VTS complications were significantly higher in TIVAPS recipients of group A (82.7%) than group B (16%) and group C (0.12%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). Defects in heart function are higher in group C (59.6%) than group A (15.8%) and group B (24.6%) in which the "tip depth of TIVAPS was deeper" (P < 0.01).
DR-assisted measurement can more accurately determine the depth of TIVAPS catheter implantation, and avoid the incidence of related complications, and provide a better method for surgeons.
在乳腺癌患者中，现代肿瘤治疗需要将化疗药物精确地注入中心静脉系统，而不产生毒性。TIVAPS 是化疗药物输送的重要方法，尽管它们的放置与某些内部或外部并发症相关。然而，TIVAPS 的长期使用仍然是一个关注的问题，以尽量减少静脉血栓综合征（VTS）和心脏缺陷等并发症。本研究旨在探讨通过数字射线照相术（DR）辅助测量与 TIVAPS 植入系统相关的导管深度来避免潜在缺点的可能性。
对 2013 年 4 月至 2017 年 11 月期间登记的 99%女性乳腺癌患者和 1%男性血液疾病患者的 5509 例 TIVAPS 接受者进行回顾性分析。将 TIVAPS 导管尖端深度进入上腔静脉的患者分为上（A 组）、中（B 组）和下（C 组）部分，在植入时进行评估；对 TIVAPS 进行 DR 辅助测量以解读“导管尖端深度”，并确定尖端深度与 VTS 和心脏缺陷等并发症的相关性。
A 组（82.7%）TIVAPS 接受者的 VTS 并发症发生率明显高于 B 组（16%）和 C 组（0.12%），其中“TIVAPS 尖端深度较深”（P<0.01）。C 组（59.6%）心脏功能缺陷发生率高于 A 组（15.8%）和 B 组（24.6%），其中“TIVAPS 尖端深度较深”（P<0.01）。
DR 辅助测量可以更准确地确定 TIVAPS 导管植入深度，避免相关并发症的发生，并为外科医生提供更好的方法。
