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Title: [Comparative study on three implantation approaches of the totally implantable venous access ports using dual-guided technique].
Author: Liu J, Lu Y, Jiang H, Wu B, Du J, Yin GW.
Journal: Zhonghua Yi Xue Za Zhi; 2020 May 05; 100(17):1332-1335. PubMed ID: 32375442.
Abstract:
Objective: To compare the clinical application effect of totally implantable venous access ports (TIVAP) via the internal jugular vein,the subclavian vein and the brachiocephalic veins under the guidance of ultrasound combined with DSA. Methods: The clinical materials of 346 patients (162 males and 184 females) who implanted TIVAP in intervention Department of Jiangsu Cancer Hospital between August 2018 and January 2019 were retrospectively reviewed and the average age was (57±12) years (17 to 83 years). The patients were divided into three groups according to the different implantation approaches. One hundred and twenty-six patients (67 males and 59 females) were group A who implanted from the internal jugular vein and the average age was (52±11) years,114 patients (52 males and 62 females) were group B who implanted from the subclavian vein and the average age was (58±10) years,106 patients (43 males and 63 females) were group C who implanted from the brachiocephalic vein and the average age was (60±9) years.The first-puncture success rate,operating time,implanting length,intraoperative pain score, one month comfort rating after surgery, unscheduled decannulation rates, early and late complication rates were compared among three groups. Results: All the patients implanted the TIVAP successfully.There were no significant differences about the first-puncture success rate (χ(2)=1.375,P=0.503),operating time (F=0.968, P=0.624), unscheduled decannulation rates (χ(2)=1.570, P=0.456), and the total pipe length among the three groups (F=0.821, P=0.441),while the catheter length inside the blood vessel were the shortest in group C (F= 263.618, P=0.000), and the one month comfort rating after surgery of group C were higher compared with group A and B (F=52.248,P=0.000).Pitch-off syndrome was a unique complication of group B (χ(2)=6.159,P=0.046) and other complications were no significant differences (P>0.05). Conclusion: There are high accuracy and safety among three implantation approaches,and the approach via brachiocephalic vein under the guidance of ultrasound combined with DSA is more comfortable and lower complication rates, which could be priority to choose. 目的： 对比分析超声联合数字减影血管造影（DSA）引导下经颈内静脉、锁骨下静脉、头臂静脉植入输液港的临床应用效果，探讨不同方式的优劣。 方法： 回顾性分析2018年8月至2019年1月江苏省肿瘤医院介入科超声联合DSA引导下植入输液港346例，其中男162例、女184例，年龄17~83（57±12）岁。按照植入路径分为经颈内静脉（A组）126例，男67例、女59例，平均年龄（52±11）岁；经锁骨下静脉（B组）114例，男52例、女62例，平均年龄（58±10）岁；经头臂静脉（C组）106例，男43例、女63例，平均年龄（60±9）岁；比较3组的一次穿刺成功率、手术时间、置管长度、术后1个月舒适度、非计划拔港率及围手术期、远期并发症发生率。 结果： 所有患者均成功植入输液港，3种路径对比一次穿刺成功率（χ(2)=1.375，P=0.503）、手术时间（F=0.968，P=0.624）、非计划拔港率（χ(2)=1.570，P=0.456）及导管总长度（F=0.821，P=0.441），差异均无统计学意义（均P>0.05）；C组血管内长度最短（F=263.618，P=0.000），且舒适度明显高于A、B组（F=52.248，P=0.000），差异有统计学意义（均P<0.05）；夹闭综合征为B组特有并发症（χ(2)=6.159，P=0.046），其余并发症发生率差异均无统计学意义（均P>0.05）。 结论： 双导向技术引导下3种植入方式均具有较高的准确性及安全性，其中经头臂静脉植入的患者术后舒适度更高，并发症发生率更少，可作为优先考虑。.

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