Klotz H P, Schöpke W, Kohler A, Pestalozzi B, Largiadèr F
Department of Surgery, Division of Visceral Surgery, University of Zurich Hospital, Switzerland.
J Surg Oncol. 1996 Jul;62(3):222-5. doi: 10.1002/(SICI)1096-9098(199607)62:3<222::AID-JSO14>3.0.CO;2-8.
Catheter fracture represents a rare problem among non-infectious complications following the insertion of totally implantable long-term central venous access systems for the application of chemotherapeutic agents. A literature survey revealed a total incidence of catheter fractures of 0-2.1%. Imminent catheter fracture can be identified radiologically, using different degrees of catheter narrowing between the clavicle and the first rib, called pinch-off sign. Two cases of catheter fracture are described and potential causes are discussed. Recommendations to avoid the pinch-off sign with the subsequent risk of catheter fracture and migration include a more lateral and direct puncture of the subclavian vein. In case of catheter narrowing in the clavicular-first rib angle, patients should be followed carefully by chest X-rays every 4 weeks. Whenever possible, the system should be removed within 6 months following insertion.
在用于化疗药物输注的完全植入式长期中心静脉通路系统置入后的非感染性并发症中，导管断裂是一个罕见问题。文献调查显示导管断裂的总发生率为0 - 2.1%。即将发生的导管断裂可通过影像学检查识别，利用锁骨与第一肋骨之间不同程度的导管狭窄，即所谓的“夹闭征”。本文描述了两例导管断裂病例并讨论了潜在原因。避免出现夹闭征及随之而来的导管断裂和移位风险的建议包括更外侧和直接地穿刺锁骨下静脉。若锁骨 - 第一肋骨夹角处出现导管狭窄，应每4周通过胸部X线对患者进行仔细随访。只要有可能，该系统应在置入后6个月内取出。
