目的

探讨乳腺癌患者使用植入式静脉输液港(IVAP)发生导管异位的情况及其安全性。

方法

回顾性分析2015年6 月至2016年3 月在重庆医科大学附属第一医院使用IVAP 化疗的360 例乳腺癌患者临床资料。 分析左右颈内静脉置管发生IVAP 导管异位的差异,以及IVAP 导管异位患者发生IVAP 相关性血栓形成的情况。 IVAP 导管异位发生率的比较采用χ² 检验或Fisher 确切概率法。

结果

360 例患者均在超声引导下经颈内静脉穿刺成功置管,其中左侧颈内静脉置管139 例,右侧颈内静脉置管221 例。 术后X 线摄影发现IVAP 导管异位患者5 例,导管位于上腔静脉者355 例。 导管异位部位为同侧颈内静脉2 例,同侧锁骨下静脉2 例,对侧无名静脉1 例。 IVAP 导管异位发生率为1.4%(5/360),其中,左右侧颈内静脉穿刺置管后导管异位发生率分别为2.2% (3/139)和0.9%(2/221),两者比较,差异无统计学意义(χ²=0.277,P=0.598)。 5 例IVAP 导管异位患者均出现无症状的IVAP 相关性血栓形成,经IVAP 回抽见血,输液通畅,无一例患者出现因导管异位所致的不适症状,对其进行严密随访,未予特殊治疗,并于化疗结束后顺利取出IVAP,中位置管时间为156 d(135 ～182 d)。

结论

乳腺癌患者化疗期间使用IVAP 化疗是一种安全有效的方法。 IVAP 导管异位发生率低,在密切随访的情况下继续使用IVAP 也是安全的。

Objective

To investigate the incidence of catheter malposition in breast cancer patients with implantable venous access port (IVAP) and explore the safety.

Methods

We retrospectively analyzed the data of 360 breast cancer patients receiving chemotherapy via IVAP in Department of Endocrine and Breast Surgery, First Affiliated Hospital, Chongqing Medical University from June 2015 to March 2016. The catheter malposition of IVAP in left and right internal jugular vein catheterization was investigated. The IVAP-related thrombosis in those patients with catheter malposition was recorded. χ² test and Fisher exact test were used to compare the rates of catheter malposition of IVAP.

Results

Totally 360 patients had successful catheterization via internal jugular veins under the guidance of ultrasound, including 139 patients via the left internal jugular vein and 221 patients via the right internal jugular vein. However,postoperative chest X-ray revealed in 5 cases and the catheter located in superior vena cava in 355 cases. The catheter malposition was located in ipsilateral internal jugular vein (2 patients), ipsilateral subclavian vein (2 patients) or contralateral innominate vein(1 patient) on the chest radiograph. The incidence of catheter malposition of IVAP was 1.4% (5/360). The incidence of catheter malposition was 2.2% (3/139) for left internal jugular vein and 0.9% (2/221) for right internal jugular vein, indicating a significant difference (χ² = 0.277, P = 0.598). Five patients had asymptomatic IVAP-related thrombosis. Blood could be pumpbacked via IVAP and the transfusion was fluent.No patients had discomfort caused by catheter malposition. All patients were closely followed up without any special treatment. IVAP was successfully removed after chemotherapy. The median catheterization duration was 156 d (range:135-182 d).

Conclusions

Application of IVAP in breast cancer patients during chemotherapy is safe and effective. The incidence of catheter malposition is low, even in catheter malposition, continuous application of IVAP is safe under close monitoring.