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植入式端口导管与外周静脉穿刺中心静脉导管用于需要化疗的癌症患者:一项基于随机对照试验的荟萃分析。

Implantable Port Catheters versus Peripherally Inserted Central Catheters for Cancer Patients Requiring Chemotherapy: An RCT-Based Meta-Analysis.

作者信息

Qiu Juan, Huang Shanshan, Wen Pei, Jiang Yingxin, Luo Zan, Zhang Wenxiong, Wen Jianyun

机构信息

Department of Thoracic Oncology Radiation Therapy, Jiangxi Cancer Hospital & Institute, Nanchang, China, 330029.

Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China, 330006.

出版信息

J Cancer. 2025 Jan 6;16(4):1127-1136. doi: 10.7150/jca.103631. eCollection 2025.

Abstract

Implantable port catheters (IPCs) and peripherally inserted central catheters (PICCs) are commonly used venous access methods for chemotherapy in cancer patients. However, the question of which is superior remains controversial. This meta-analysis, based on randomized controlled trials (RCTs), systematically compares the safety, cost, and impact on quality of life between these two methods. Eligible RCTs comparing IPC and PICC were identified through searches in seven databases. Complications were the primary endpoint, while secondary endpoints included cost, impact on chemotherapy, and quality of life assessments. Six studies based on five RCTs, including a total of 1,127 patients, were analyzed. Patient data indicated that the PICC group experienced a higher incidence of total complications, thrombosis, deep vein thrombosis, implantation failure, unplanned catheter removal, and local reactions. Conversely, the IPC group had a higher incidence of pocket infection/exit-site infection without septicemia and pain. When considering catheter days, the PICC group again showed a higher incidence of total complications, thrombosis, deep vein thrombosis, implantation failure, unplanned catheter removal, edema, and local reactions. Complication-free survival was better in the IPC group. Although the impact on chemotherapy tended to favor the IPC group, this difference was not statistically significant. The total cost was higher in the IPC group, while the cost per catheter day was similar between the two groups. Quality of life assessments (using EORTC QLQ-C30) revealed similar global health status between the two groups during the post-implantation, mid-treatment, and end-treatment periods. However, the IPC group experienced a smaller decline in global health status post-implantation compared to the PICC group. Compared to PICC, IPC appears to be a safer and more comfortable intravenous catheterization option for cancer patients undergoing chemotherapy.

摘要

植入式端口导管(IPCs)和外周静脉穿刺中心静脉导管(PICCs)是癌症患者化疗常用的静脉通路方法。然而,哪种方法更具优势仍存在争议。这项基于随机对照试验(RCTs)的荟萃分析系统地比较了这两种方法在安全性、成本以及对生活质量的影响。通过检索七个数据库,确定了比较IPCs和PICCs的合格RCTs。并发症是主要终点,而次要终点包括成本、对化疗的影响以及生活质量评估。分析了六项基于五项RCTs的研究,共纳入1127例患者。患者数据表明,PICC组在总并发症、血栓形成、深静脉血栓形成、植入失败、计划外拔管和局部反应方面的发生率更高。相反,IPCs组在无败血症的口袋感染/出口部位感染和疼痛方面的发生率更高。考虑导管使用天数时,PICC组在总并发症、血栓形成、深静脉血栓形成、植入失败、计划外拔管、水肿和局部反应方面的发生率再次更高。IPCs组的无并发症生存期更好。尽管对化疗的影响倾向于支持IPCs组,但这种差异无统计学意义。IPCs组的总成本更高,而两组的每日导管成本相似。生活质量评估(使用EORTC QLQ-C30)显示,两组在植入后、治疗中期和治疗末期的总体健康状况相似。然而,与PICC组相比,IPCs组在植入后总体健康状况的下降幅度较小。与PICC相比,对于接受化疗的癌症患者,IPCs似乎是一种更安全、更舒适的静脉置管选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd59/11786043/7199dd62bbf8/jcav16p1127g001.jpg

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