Liu Chuan, Yang Dandan, Guo Xia, Wang Jiao, Wang Rui, Qu Haibo, Liu Lingjun
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
Department of Radiology, the Third People's Hospital of Chengdu, Chengdu, China.
J Vasc Interv Radiol. 2025 Oct;36(10):1513-1522.e8. doi: 10.1016/j.jvir.2025.06.008. Epub 2025 Jun 21.
To evaluate the adverse events associated with tunneled central venous catheters (CVCs) and totally implantable venous access device (TIVAD) in patients of pediatric oncology undergoing chemotherapy.
A comprehensive search was retrospectively conducted using PubMed, Embase, Web of Science, and the Cochrane Library to identify studies. Cohort studies and randomized controlled trials comparing tunneled CVCs with TIVAD in patients of pediatric oncology were included. Quality was assessed via the Cochrane Collaboration tool for randomized controlled trials and Newcastle-Ottawa Scale for cohort studies. Random-effects meta-analysis was used to calculate the odds ratio (OR).
Twenty-four observational studies were included, with 4,100 in the tunneled CVC group and 3,294 in the TIVAD group. TIVAD were associated with decreased risk for systemic infection (OR, 2.28; 95% confidence interval [CI], 1.57 to 3.32; P < .001; I = 76%, 17 studies), mechanical failure (OR, 2.35; 95% CI, 1.46 to 3.78; P < .001; I = 75%, 14 studies), and premature device removal (OR, 3.65; 95% CI, 2.82 to 4.73; P < .001; I = 48%, 15 studies). There was no significant difference in the risk of localized infection (OR, 2.37; 95% CI, 0.95 to 5.91; P = .06; I = 84%; 6 studies) and symptomatic venous thrombosis (OR, 1.48; 95% CI, 0.84 to 2.63; P = .17; I = 22%; 8 studies) between tunneled CVCs and TIVAD.
TIVAD were associated with a lower incidence of catheter-associated adverse events compared with tunneled CVCs, suggesting they may be a preferred option for chemotherapy in patients of pediatric oncology.
评估在接受化疗的小儿肿瘤患者中，带隧道中心静脉导管（CVC）和全植入式静脉通路装置（TIVAD）相关的不良事件。
使用PubMed、Embase、科学网和Cochrane图书馆进行了一项全面的回顾性检索以确定研究。纳入了比较小儿肿瘤患者中带隧道CVC与TIVAD的队列研究和随机对照试验。通过Cochrane协作网随机对照试验工具和纽卡斯尔-渥太华量表对队列研究进行质量评估。采用随机效应荟萃分析计算比值比（OR）。
纳入24项观察性研究，带隧道CVC组4100例，TIVAD组3294例。TIVAD与全身感染风险降低相关（OR，2.28；95%置信区间[CI]，1.57至3.32；P <.001；I² = 76%，17项研究）、机械故障风险降低相关（OR，2.35；95%CI，1.46至3.78；P <.001；I² = 75%，14项研究）以及装置提前移除风险降低相关（OR，3.65；95%CI，2.82至4.73；P <.001；I² = 48%，15项研究）。带隧道CVC与TIVAD在局部感染风险（OR，2.37；95%CI，0.95至5.91；P = 0.06；I² = 84%；6项研究）和有症状静脉血栓形成风险（OR，1.48；95%CI，0.84至2.63；P = 0.17；I² = 22%；8项研究）方面无显著差异。
与带隧道CVC相比，TIVAD与导管相关不良事件的发生率较低相关，提示它们可能是小儿肿瘤患者化疗的首选选择。
