【摘要】 目的探讨DSA引导下植入式静脉输液港在恶性肿瘤患者中的应用。方法随访分析2013年4月—2016年3月在DSA引导下植入静脉输液港的恶性肿瘤患者的病例资料,观察并记录输液港植入的过程、并发症的发生及处理方法。结果 83例恶性肿瘤患者完成静脉输液港植入术,其中经锁骨下静脉入路75例,右颈内静脉入路7例,右股静脉入路1例。操作成功率100%,其中一次性静脉穿刺成功率为93.98%(78/83)。围手术期并发症的发生率为1.20%(1/83),表现为输液不畅。远期并发症的发生率为7.23%(6/83),包括术后局部皮肤感染1例,发生在术后第10个月,经抗感染治疗后治愈;导管血栓形成1例,发生在术后第8个月,经抗凝处理后取出输液港;导管堵塞1例,证实纤维蛋白鞘形成,经尿激酶处理无效后取出输液港;导管夹闭综合征3例,其中1例在术后第22个月导管断裂进入左肺动脉,通过抓捕器经右股静脉入路取出,1例在术后16个月因输液后肩膀酸痛拆除输液港,1例患者表现为输液不畅,植入输液港后6个月死于晚期肺癌。结论 DSA引导下植入静脉输液港操作简单、可视、定位准确,并发症少,可为恶性肿瘤提供长期、安全、方便的静脉通道,值得临床推广。更多还原

【Abstract】 Objective To explore the application of implantable venous access port(IVAP)under DSA guidance in cancer patients.Methods Cancer patients who were used IVAP under DSA guidance from April 2013 to March 2016 were observed and the operation process,the occurrence and treatment of complications in IVAP were recorded.Results Totally83 cancer patients in which 75 cases by subclavian vein approach,7cases by the right internal jugular vein approach and 1case by the right femoral vein approach were implemented IVAP.Operation success rate was 100%,with the success rate of 93.98%(78/83)on first attempt.The overall incidence of postoperative complication was 1.20%(1/83),which showed poor transfusion.Long-term complication rate was 7.23%(6/83).One case of postoperative local skin infections occurred in the tenth month after operation,finally was cured via anti-infection treatment;Catheter thrombosis in one case occurred in the eighth month after operation,taking out of the IVAP after Anticoagulation;Catheter occlusion was in one case and fibrin sheath formed,ineffective treatment by urokinase to demolish the port;Catheter pinch-off syndrome were found in 3cases,including one case breaking into the left pulmonary artery in twenty-two months later after operation and removing via the right femoral vein approach by arresting device,one case removing the IVAP because of shoulder pain after infusion,one patient poor transfusion,death of advanced lung cancer half year later after operation.Conclusion IVAP under DSA guidance is simple,visual,accurate positioning and fewer complications,which can provide long-term,safe and convenient venous access for cancer patients,worthy of promotion.更多还原