超声导引下上臂完全植入式输液港植入临床应用

目的 探讨超声导引下上臂完全植入式输液港(TIAP)植入的安全性、技术可行性及相关并发症.方法 选择2014年2月至2016年12月接受上臂植入TIAP患者642例,其中男407例(63.4％),女235例(36.6％),年龄11～89(58.29±4.33)岁.采用超声导引下Seldinger置管技术,于上臂植入TIAP.结果 642例患者均植入上臂TIAP,首次植入成功率99.53％ (639/642),3例首次穿刺失败,第2次植入成功.随访155 302个导管日,共发生并发症58例(9.0％),其中近期并发症9例,远期并发症49例;TIAP相关感染28例(4.4％),导管静脉血栓7例(1.1％),囊袋出血3例(0.4％),TIAP体翻转3例(0.4％),皮肤裂开1例(0.2％),导管堵塞2例(0.3％),导管继发移位4例(0.6％),导管相关上肢运动受限7例(1.1％),上肢静脉回流障碍2例(0.3％),正中神经损伤1例(0.2％),无相关死亡事件发生.结论 超声导引下经皮穿刺上臂植入TIAP技术安全有效,创伤小,并发症发生率低,值得临床推广应用.

Clinical application of ultrasound-guided implantation of totally implantable access port in the upper arm

Objective To explore the safety,technical feasibility,and catheter-related complications of ultrasound-guided implantation of totally implantable access port (TIAP) in the upper arm.Methods A total of 642 patients,who were admitted to authors' hospital during the period from February 2014 to December 2016 to receive ultrasound-guided implantation of TIAP in the upper arm,were enrolled in this study.The patients included 407 males (63.4％) and 235 females (36.6％),their age ranged from 11 to 89 years old,with a mean age of (58.29±4.33) years old.Under ultrasound guidance,by using Seldinger's technique TIAP was implanted in the upper arm.Results Implantation of TIAP in the upper arm was performed in all 642 patients.The initial success rate of implantation was 99.53％ (639/642),in 3 patients successful implantation was obtained in the second time of implantation as the initial puncturing failed.During the follow-up of 155,302 catheter days,complications occurred in a total of 58 patients (9.0％),including early complications in 9 patients and late complications in 49 patients.The complications included TIAP-related infection (n=28,4.4％),venous thrombosis (n=7,1.1％),sac bleeding (n=3,0.4％),port hub rotation (n=3,0.4％),cracked skin (n=l,0.2％),catheter obstruction (n=2,0.3％),catheter displacement (n=4,0.6％),movement restriction of catheter-side upper limb (n=7,1.1％),venous return obstruction of upper limb (n=2,0.3％) and median nerve injury (n=l,0.2％).No port-related death occurred.Conclusion The ultrasoundguided implantation of TIAP in the upper arm is technically-safe,clinically-effective and minimally-invasive,besides,it carries lower incidence of complications.Therefore,this method is worthy of clinical popularization and application.