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用于实体瘤化疗的、连接到Groshong导管的长期完全植入式中心静脉通路端口:178例使用单一类型装置的经验

Long-term, totally implantable central venous access ports connected to a Groshong catheter for chemotherapy of solid tumours: experience from 178 cases using a single type of device.

作者信息

Biffi R, Corrado F, de Braud F, de Lucia F, Scarpa D, Testori A, Orsi F, Bellomi M, Mauri S, Aapro M, Andreoni B

机构信息

Division of General Surgery 2, European Institute of Oncology, Milan, Italy.

出版信息

Eur J Cancer. 1997 Jul;33(8):1190-4. doi: 10.1016/s0959-8049(97)00039-7.

Abstract

The aim of this study was to examine the early and late complications rate of central venous access ports connected to the Groshong catheter for long-term chemotherapy delivering. All patients suffering from a neoplastic disease, who required long-term chemotherapy and underwent insertion of implantable ports during a 21-month period (1 October 1994-30 June 1996) were prospectively studied. A single type of port was used, constructed of titanium and silicone rubber (Dome Port, Bard Inc., Salt Lake City, U.S.A), connected to an 8 F silastic Groshong catheter tubing (Bard Inc.). A team of different operators (two general surgeons, one interventional radiologist and four anaesthesiologists) was involved in inserting the port. All devices were placed in the operating room under fluoroscopic control. A central venous access form was filled in by the operator after the procedure and all ports were followed prospectively for device-related and overall complications. Data from the follow-up of these patients were entered in the form and collected in a database. Follow-up continued until the device was removed, the patient died or the study was closed. 178 devices, comprising a total of 32,089 days in situ, were placed in 175 patients. Three patients received a second device after removal of the first. Adequate follow-up was obtained in all cases (median 180 days, range 4-559). 138 devices (77.5%) were still in situ when the study was closed. Early complications included six pneumothoraxes, three arterial punctures and two revisions for port and/or catheter malfunction (overall early complications in 8 patients). Late complications included 3 cases (1.68% of devices) of catheter rupture and embolisation (0.093 episodes/1000 days of use), 2 cases (1.12% of devices) of venous thrombosis (0.062 episodes/1000 days of use), 1 case (0.56% of devices) of pocket infection (0.031 episodes/1000 days of use), and 4 cases (2.24% of devices) of port-related bacteraemias (0.124 episodes/1000 days of use). Infections were caused by coagulase-negative Staphylococcus aureus (4 cases) and Bacillus subtilis (1 case); they required port removal in 3 out of 5 cases. This study represents the largest published series of patients with totally implantable access ports connected to Groshong catheters; this device is a good option for long-term access to central veins and delivery of chemotherapeutic regimens, including continuous intravenous infusions. The low incidence of major complications related to implantation and management of these devices support increased use in oncology patients.

摘要

本研究的目的是检查与Groshong导管相连的中心静脉通路端口用于长期化疗给药的早期和晚期并发症发生率。对所有患有肿瘤疾病、需要长期化疗并在21个月期间(1994年10月1日至1996年6月30日)接受植入式端口插入术的患者进行前瞻性研究。使用了单一类型的端口,由钛和硅橡胶制成(Dome Port,美国犹他州盐湖城的巴德公司),连接到一根8F的硅橡胶Groshong导管(巴德公司)。一个由不同操作人员组成的团队(两名普通外科医生、一名介入放射科医生和四名麻醉医生)参与了端口的插入操作。所有装置均在手术室的荧光透视控制下放置。术后操作人员填写一份中心静脉通路表格,对所有端口进行前瞻性跟踪,记录与装置相关的并发症和总体并发症。这些患者的随访数据录入表格并收集到数据库中。随访持续到装置取出、患者死亡或研究结束。175例患者共植入了178个装置,累计在位32089天。三名患者在取出第一个装置后接受了第二个装置。所有病例均获得了充分的随访(中位随访时间180天,范围4 - 559天)。研究结束时,138个装置(77.5%)仍在位。早期并发症包括6例气胸、3例动脉穿刺以及2例因端口和/或导管故障进行的修复(8例患者出现总体早期并发症)。晚期并发症包括3例(占装置的1.68%)导管破裂和栓塞(0.093次/1000天使用时间)、2例(占装置的1.12%)静脉血栓形成(0.062次/1000天使用时间)、1例(占装置的0.56%)囊袋感染(0.031次/1000天使用时间)以及4例(占装置的2.24%)与端口相关的菌血症(0.124次/1000天使用时间)。感染由凝固酶阴性金黄色葡萄球菌(4例)和枯草芽孢杆菌(1例)引起;5例中有3例需要取出端口。本研究是已发表的与Groshong导管相连的完全植入式通路端口患者系列中规模最大的;该装置是长期进入中心静脉和进行化疗方案给药(包括持续静脉输注)的良好选择。与这些装置植入和管理相关的主要并发症发生率较低,支持在肿瘤患者中增加使用。

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