应用抗生素锁技术预防婴幼儿输液港感染的随机对照研究

目的探索抗生素锁技术在预防婴幼儿肿瘤患者出现植入式静脉输液港相关感染并发症中的效果。方法选取首都医科大学附属北京世纪坛医院60例确诊神经系统恶性肿瘤并接受手术放置植入式静脉输液港的婴幼儿患者，进行随机对照研究，实验组30例患儿在术后预防性使用抗生素锁技术封管，对照组30例患儿单纯使用肝素盐水封管，按严格随访计划观察所有患儿在术后1个月中是否出现感染并发症，比较两组间的差异并寻找导致感染并发症的危险因素。结果两组患儿一般情况的组间比较差异无统计学意义（P<0.05），预防性使用抗生素锁技术组的患儿术后感染率为3.33%，而对照组患儿的术后感染率为13.33%，两组比较差异无统计学意义（P=0.353）；分析后未发现导致感染并发症出现的独立危险因素。结论预防性应用抗生素锁技术可能会在一定程度上减少婴幼儿肿瘤患者植入式静脉输液港相关感染并发症的发生率，但需要后续扩大样本量深入研究来证实其临床效果。     

植入式静脉输液港发生皮氏罗尔斯顿菌感染一例

正植入式静脉输液港(implantable venous access port,IVAP)是一种可植入皮下、长期留置体内的中心静脉装置,具有携带方便、维护费用低、不影响患者生活质量等优势。近年来,其被国内多家医院的乳腺中心接受并应用于临床~([1]),成为乳腺癌患者完成多个疗程化疗的最佳静脉通路,但使用过程中也会出现并发症,其中导管相关感染最为常见。Fischer~([2])、Narducci等~([3])报道,IVAP应用过程中,46. 2%     

植入式静脉输液港预防恶性肿瘤化疗患者并发症的效果

目的探讨植入式静脉输液港预防恶性肿瘤化疗患者并发症的效果。方法选取2011年10月至2014年10月间收治的106例肿瘤化疗患者,根据随机数字表法分为观察组和对照组,每组各53例。观察组患者行植入式静脉输液港治疗,对照组患者行外周静脉置入中心静脉导管治疗,比较两组患者的并发症发生情况。结果观察组患者导管堵塞发生率为(0.0%)、导管相关性感染发生率为(3.8%)、药液外渗发生率为(1.9%)、导管脱落或断裂发生率为(0.0%)、血栓发生率为(0.0%)、Pinch-off综合征发生率为(0.0%)均明显低于对照组(分别为7.5%、17.0%、13.2%、7.5%、9.4%和7.5%),差异均有统计学意义(均P<0.05)。结论植入式静脉输液港可显著降低肿瘤化疗患者并发症发生率,值得临床推广使用。     

植入式静脉输液港导管异位的安全性探讨

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χ~2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(χ~2=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。     

上臂输液港并发多发性血栓一例

正植入式静脉输液港(implantable venous access port,IVAP)简称输液港,是一种在人体内可长期留置的静脉输液装置,适用于完全胃肠营养、高浓度化疗药物等的输注,能减少患者因反复静脉穿刺带来的痛苦[1]。与中心静脉导管(central venous catheter,CVC)和外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相比,IVAP具有留置时间长、维护周期长、美观舒适、     

输液港在乳腺癌患者化疗中的临床应用

肿瘤患者因反复的血管穿刺和化疗药物本身的毒性易致穿刺血管形成血栓和静脉炎[1],严重的影响了患者的生活质量和生命安全。植入式静脉输液港（ implantable venous access port, IVPA）是一种可植入皮下,长期留置在体内的静脉输液装置,通过使用无损伤针穿刺植入皮下输液港即可建立输液通道,可进行输注药物、补液、营养支持、输血等治疗。 IVPA最常见的植入方式有锁骨下静脉路径和颈内静脉路径,但因锁骨下路径易发生夹闭综合征（ pinch-off syndrome）导致严重并发症,因此,临床多选择颈内静脉植入。2012年11月至2013年5月本院共完成超声引导下经颈内静脉途径输液港安置术50例,患者化疗结束后均顺利拔出输液装置。笔者将临床应用情况及体会总结如下。     

腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用比较

目的:探讨腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用效果。方法:选择2017年1月至2018年12月住院行腹腔化疗的卵巢癌患者90例,其中腹腔穿刺组患者45例,腹腔输液港组患者45例。对比2组患者的治疗效果、导管相关并发症发生情况、穿刺时疼痛评分、一次性穿刺成功率以及疗程完成情况。结果:两组患者治疗效果比较差异无统计学意义（P>0.05）;导管相关并发症发生情况,两组比较差异无统计学意义（P>0.05）;腹腔输液港组患者穿刺疼痛评分低于腹腔穿刺组,两组M(P25,P75)评分分别为2.00（1.40,2.50）和5.33（5.00,5.67）,差异具有统计学意义（P<0.05）,腹腔输液港组患者有18例主诉在留置期间存在腹部异物感;腹腔穿刺组患者一次性穿刺成功率为87.44%（181/207）,腹腔输液港组患者为95.04%（249/262）,两组比较差异具有统计学意义（P<0.05）;腹腔穿刺组患者疗程完成率为82.22%（37/45）,腹腔输液港组为95.56%（43/45）,差异具有统计学意义（P<0.05）。结论:腹腔输液港相较于腹腔穿刺应用于腹腔化疗中,其一次性穿刺成功率更高,疗程完成度更好,故在经济条件允许且化疗周期较长、腹部穿刺困难或对疼痛不耐受的患者可考虑置入腹腔输液港。     

植入式静脉输液港在肿瘤化疗中的应用及常见并发症的护理

目的分析植入式静脉输液港（central verlous port Access system,VAP）临床应用并发症发生的原因,探讨处理及预防措施。方法回顾性分析87例肿瘤患者进行VAP植入化疗,并行局部护理和管腔通畅护理等,总结并发症例数及原因。结果 87例患者中,植入置管失败2例,置管成功率为97.70%。17例出现并发症,发生率为19.54%。近期并发症4例,其中术后气胸1例、切口感染1例、局部血肿1例、导管锁松脱致局部渗液1例;远期并发症13例,其中输液障碍7例、导管相关性感染3例、导管夹闭综合征3例。结论加强医务人员规范化培训、穿刺植入前对患者进行全面评估和提高置管医生的穿刺技术有利于减少VAP近期并发症的发生;植入后的精心护理可有效减少VAP临床应用远期并发症的发生。     

植入式静脉输液港在肿瘤化疗中的应用及常见并发症的护理

目的 分析植入式静脉输液港(central verlous port Access system,VAP)临床应用并发症发生的原因,探讨处理及预防措施.方法 回顾性分析87例肿瘤患者进行VAP植入化疗,并行局部护理和管腔通畅护理等,总结并发症例数及原因.结果 87例患者中,植入置管失败2例,置管成功率为97.70%.1...     

TIVAP和PICC在肿瘤化疗和营养支持中的应用及并发症比较

目的研究经锁骨下静脉完全植入式输液港（totally implantable venous—accessports,TIVAP）和经外周中心静脉置管（peripherally inserted centralcatheterization,PICC）两种不同方法在肿瘤患者化疗及肠外营养支持期间应用的优劣。方法回顾性分析2007年6月至2011年12月481例采用TIVAP和PICC两种途径中心静脉置管肿瘤患者的临床资料,对两组患者的并发症进行比较和分析。结果TIVAP组置管失败率、导管阻塞率、感染发生率、湿疹发生率、导管滑脱率均低于PICC组（P〈0．05）;两组二次置管率、暂时性上肢功能障碍发生率无差别（P〉0．05）。结论TIVAP为肿瘤患者提供了更安全的化疗方式,可有效减少患者痛苦,降低置管并发症,延长留置时间。     

Regional arterial chemotherapy of liver tumours. I. Performance comparison between a totally implantable pump and a conventional access system

Thirty-nine patients with liver tumours have been submitted to regional arterial chemotherapy by means of either totally implantable Infusaid-400 pumps (22 c.) or implantable ports (17 c.). The latter were subsequently perfused with external pumps. There was one single major operative complication and no operative deaths. Most patients underwent continuous Fudr infusion. Access related complications occurred in both groups. Treatment was stopped for access related complications in 18.4% and 29.4% of cases out of the pump and port groups respectively. In most of those cases, however, several cycles of chemotherapy had already been performed. The Infusaid-400 pumps showed a 12-month functional duration of 57% with a 13-month median, the 10-month duration of ports being 67%. The difference was not significant. The new implantable systems give better results in comparison with traditional regional access methods, the functional performances of the port systems appearing very similar to the totally implantable pumps, with an obvious advantage for the pumps as far as quality of life is concerned.     

Intra-arterial infusion chemotherapy for advanced cancer--40 years of experience

During the period of 1990-2005, 701 patients with the hepatocellular carcinoma were treated with intra-arterial infusion of 5-FU and epi-adriamycin with or without Lipiodol chemoembolization employing an implantable infusion port system. In 70% of the patients treated, an objective response was observed with marked regression of tumor and decrease in tumor marker (AFP and PIVKA-II). Also 1,091 patients with the metastatic liver cancer of colon, rectum, stomach and pancreas were treated with the same procedure employing 5-FU, mitomycin C, adriamycin, or epi-adriamycin. In more than 80% of the patients treated, an objective response was observed with marked regression of tumor and decrease in tumor marker (CEA, CA19-9, TPA, DUPAN-2, SPan-1). Intra-arterial infusion chemotherapy employing an implantable port system also proved to be a promising treatment modality for most of the intractable head and neck cancer, breast cancer and a few of the pancreas cancer.     

Clinical outcome of totally implantable subcutaneous infusion port--comparison with home parenteral nutrition and chemotherapy

We investigated long-term clinical findings in a total of 107 cases with a subcutaneous infusion port. Some 109 patients were implanted with a subcutaneous infusion port at our institution from 1994 to 2003. The patients' ages ranged from 1 to 93 years (average 58.1 years). Implantation failed in 2 patients because it was impossible to insert the guide wire into the central vein and because of mediastinal hematoma due to injury to the central vein from the dilator. 32 patients had complications after catheter system exchange, 17 suffered port infection, 9 had obstruction of the catheter system, and 3 developed ulcerations from the port system. Two cases were given subcutaneous injection due to port system breakage, and one case experienced pain from the port puncture needle. The use of a totally implantable subcutaneous infusion port is widespread for chemotherapy access or home parenteral nutrition in patients with malignancy or malnutrition. This catheter system is useful for improvement of patient's quality of life. However, once complications occur, patient's condition might become worse. Appropriate measures must be taken when complications occur.     

Implantable catheter system for long-term intravenous chemotherapy

Fifty-three implantable catheter systems (Port-A-Cath) were placed subcutaneously in 48 patients with malignant tumours. This device consists of a stainless steel chamber covered by a silicone membrane connected to a silicone catheter placed in a central vein. All systems were used for administration of chemotherapy. The mean function time was 187 days (range 0-867). Complications necessitating reoperation occurred in six patients. In three cases, the catheter occluded from thromboses. In two patients, wound dehiscence occurred, and in one a wound infection developed. In one case, the catheter was disconnected from the port. Four patients who had had the port removed later received new ports. One patient had the second port removed and was given a third catheter system. It is concluded that subcutaneously implantable injection ports constitute a safe and convenient access for long-term intravenous chemotherapy. The complication rate is low, and it should be possible to avoid most recorded complications in the future.     

CAP方案不同用药途径治疗非小细胞肺癌疗效比较

目的：比较ＣＡＰ方案经支气管动脉灌注与外周静脉用药治疗非小细胞肺癌的疗效。方法：４５例患随机分为Ａ、Ｂ两组,均用ＣＡＰ方案治疗,Ａ组经支气管动脉灌注用药,Ｂ组经外周静脉用药,均治疗３个疗程。结果：Ａ组ＣＲ１４．３％,ＰＲ５７．１％,Ｂ组ＣＲ为Ｏ,ＰＲ３７．５％,毒副反应：Ａ组的Ⅱ～Ⅲ度骨髓抑制及消化道反应均低于Ｂ组（Ｐ〈０．０５）。结论：ＣＡＰ方案治疗非小细胞肺癌经支气管动脉灌注疗效优于经外周静     

Clinical experience of a subcutaneously implantable drug delivery catheter (PORT-A-CATH)

A drug delivery catheter system with subcutaneously implantable port, PORT-A-CATH, was applied for intra-arterial, intravenous and intraperitoneal chemotherapy and hyperalimentation in treating 99 cancer patients. The average implantation period was 135.1 days and this system was applied for more than one year in 5 cases. Any troubles due to port or catheter materials were not observed during the study. Catheter occlusion occurred in 11 cases infection in 7 (catheter-related infection 4, pocket infection 3), and skin necrosis in 4. This system was proved useful to reduce the risk of infection and enabled easy and safe long-term repeated administration, compared to the catheters with external end. Intra-arterial chemotherapy became possible to the outpatients with the use of this system, which seemed to contribute for the improvement of quality of life of the patients.     

Arterial infusion chemotherapy for advanced gallbladder cancer and liver metastasis

Ten patients with advanced gallbladder cancer were treated by arterial infusion chemotherapy. Seven patients had unresected tumors, and three had liver metastasis after resection of primary tumor. The infusion catheter-port system was implanted via the femoral artery. 5-fluorouracil, mitomycin C and epirubicin were administered using implantable port. The response rate was 50% and the median survival time was 192 days. In one patient with good PR, a primary tumor was resected, and he survived for 2 years 7 months without recurrence. No severe side effect was found. Systemic chemotherapy using gemcitabine is well accepted, however arterial infusion chemotherapy will be one of the options when systemic chemotherapy is fails.     

恩度静脉持续泵入与滴注联合含铂双药方案化疗治疗晚期非小细胞肺癌的疗效与安全性比较

目的 探讨恩度静脉持续泵入与滴注联合含铂双药方案一线化疗治疗晚期非小细胞肺癌(Non-small cell lung cancer,NSCLC)的临床疗效与安全性.方法 选取武汉大学人民医院2011年12月—2020年12月收治的100例病理分型为腺癌的晚期NSCLC患者作为研究对象,观察组为恩度静脉持续泵入(CIV)...     

Central venous access port-related complications in outpatient chemotherapy for colorectal cancer

BACKGROUND: The current standard chemotherapy for advanced or metastatic colorectal cancer in Japan is FOLFOX or FOLFIRI therapy. Although both therapies include continuous infusion of 5-fluorouracil (5-FU), outpatient home chemotherapy is possible by placing a central venous access port (CV-port) and using a portable disposable pump. The port system has been placed more frequently since the approval of FOLFOX. Consequently, more complications involving ports and pumps have been encountered. METHODS: At our hospital, 232 patients with colorectal cancer underwent outpatient home chemotherapy by placing a CV-port and using a portable disposable pump for continuous infusion of 5-FU between 1998 and 2005. Incidence and contents of complications involving ports and pumps were investigated retrospectively. RESULTS: A total of 54 incidents of complications involving ports and pumps were identified in 3142 treatments (1.72%) from among 34 of the 232 patients (14.7%). In 2005, when FOLFOX was introduced, 31 incidents occurred in 1903 treatments (1.63%) for 19 of 149 patients (12.8%). Incidents involved port placement (n = 6), catheter and port system-related complications (n = 15), puncture needle-related complications (n = 3), skin complications related to tape fixation (n = 20) and pump-related complications (n = 10). In 10 patients (4.3%), system-related complications made therapy difficult to continue and system exchange was required. CONCLUSIONS: Technical troubles involving ports and pumps occurred at a certain rate, and skin incision was required for system exchange in some cases. When performing outpatient chemotherapy using ports and pumps, thorough prior guidance and double-checking must be implemented, and proper countermeasures must be established.     

Hepatic arterial infusion chemotherapy with 5-fluorouracil-based regimens in the management of liver metastases of colorectal carcinoma

Background We assessed the efficacy and safety of hepatic arterial infusion chemotherapy, using 5-fluorouracil-based regimens, in the treatment of unresectable liver metastases of colorectal carcinoma. Patients and Methods Thirty patients with liver metastases of colorectal carcinoma were given hepatic arterial infusion chemotherapy using 5-fluorouracil-based regimens, through an implantable port system, inserted into the hepatic artety by percutaneous procedures. Weekly 5-fluorouracil infusions were given to 17 patients, daily 5-fluorouracil infusions were given to 2, the MF (5-fluorouracil-mitomycin) regimen was given to 8, and the FEM (5-fluorouracil-epirubicin-mitomycin) regimen was given to 3. Results The median survival time was 11.6 months, with an overall response rate of 64%. These results were similar to those in previous reports on hepatic arterial infusion chemotherapy using floxuridine. Hematologic and hepatic toxicity was minimal Grade 3 thrombocytopenia occurred in 2 patients (7%), and a grade 2 elevation of alkaline phosphatase, in 1 (4%). Biliary sclerosis was not observed. The major toxicity was nausea and vomiting, grade 2 or 3, most of which was controllable, in 5 patients (18%). The occurrence of hepatic failure resulting in death was significantly (P=0.0015) lower in responsive cases than in nonresponsive cases. Conclusion We consider that 5-fluorouracil-based regimens can be used safely for hepatic arterial infusion chemotherapy with minimal toxicity, and that they are useful in preventing hepatic failure, because of their high response rate.