Di Giorgio A, Bangrazi C, Canavese A, Arnone P, Corsetti F B, Pallotti M, al Mansour M
I Istituo di Clinica Chirurgica, Università degli Studi di Roma La Sapienza.
Ann Ital Chir. 1997 Jul-Aug;68(4):529-36; discussion 536-7.
The use of totally implantable systems (TIS) has noticeably reduced risks and enhanced quality of life for cancer patients undergoing long-term chemotherapy. One aspect remains open to discussion: site of venous access and placement procedure. Opinions are divided between two techniques: percutaneous access by direct puncture of the subclavian vein or surgical access through the veins afferent to the subclavian: the cephalic, the jugular, or other minor veins. We report our experience with 63 patients undergoing surgical placement of TIS through the cephalic vein. The operatory procedure is divided into four phases: 1) Preparation of vein and cannulation; 2) X-ray control; 3) creation of subcutaneous sheath; 4) reconstruction. None of the 63 patients developed immediate complications. 46 patients are currently using TIS for a period ranging from 17 to 1862 days. 16 patients died during the time their TIS was in place. In only one patient was the TIS removed after treatment was completed. From our results it is clear that the surgical access through the cephalic vein is the most reliable method of TIS placement, with fewer risks concerning immediate and post operatory complications.
全植入式系统（TIS）的使用显著降低了接受长期化疗的癌症患者的风险，并提高了他们的生活质量。有一个方面仍有待讨论：静脉通路的部位和放置程序。两种技术的观点存在分歧：通过直接穿刺锁骨下静脉进行经皮通路或通过汇入锁骨下静脉的静脉进行手术通路，即头静脉、颈静脉或其他小静脉。我们报告了63例通过头静脉进行TIS手术植入的患者的经验。手术过程分为四个阶段：1）静脉准备和插管；2）X线控制；3）皮下鞘的创建；4）重建。63例患者均未出现即刻并发症。46例患者目前正在使用TIS，使用时间为17至1862天。16例患者在TIS植入期间死亡。治疗完成后仅1例患者取出了TIS。从我们的结果可以明显看出，通过头静脉进行手术通路是TIS放置最可靠的方法，在即刻和术后并发症方面风险较小。
