摘要
目的探讨完全植入式静脉输液港(totally implantable venous access port,TIVAP)在白血病婴幼儿手术操作及术后维护中的特点及技术改进。方法采用回顾性研究方法,收集2020年9月至2023年12月于首都医科大学附属北京儿童医院黑龙江医院行TIVAP植入手术的5例白血病婴幼儿的信息。分析TIVAP使用及维护的相关资料,包括手术操作、术后维护、近远期并发症的出现和处理及拆港等信息。结果5例患儿均在全身麻醉下成功完成超声引导颈内静脉穿刺置管TIVAP植入手术。其中男1例,女4例;年龄0.39~4.66岁,平均(1.92±1.65)岁;右侧颈内静脉置管4例,左侧颈内静脉置管1例;因疾病进展死亡1例(置港后1年),正在使用1例,2例因“定期来院维持治疗”期间发生导管相关性血流感染(catheter-related bloodstream infection,CRBSI)被动拆港(分别为置港后13、19个月),1例化疗完成计划内拆港。应用中发生药物外渗2例,CRBSI 2例,导管内血栓形成1例,拆港前超声提示不同程度的导管表面纤维蛋白鞘形成3例。结论TIVAP可满足婴幼儿化疗人群的静脉输液需求,规范操作下应用安全、优势明显、实用性强。
Objective To explore the characteristics and technical improvements of totally implantable venous access port(TIVAP)in surgical procedures and postoperative maintenance for children with leukemia.Method Using a retrospective study method,data were collected from five children with leukemia who underwent TIVAP implantation at Heilongjiang Hospital Affiliated to Beijing Children's Hospital,Capital Medical University from September 2020 to December 2023.Information related to the use and maintenance of TIVAP was analyzed,including surgical procedures,postoperative maintenance,occurrence and management of short-term and long-term complications,and port removal.Result All five children successfully underwent ultrasound-guided internal jugular vein catheterization and TIVAP implantation under general anesthesia.Among them,one was male and four were female,with a median age of(1.92±1.65)years(ranged from 0.39 to 4.66 years).Catheterization was performed via the right internal jugular vein in four cases and the left internal jugular vein in one case.One child died due to disease progression(1 year after port placement),one child was currently using the port,two children underwent unplanned port removal due to catheter-related bloodstream infection(CRBSI)during"routine hospital maintenance therapy"(13 months and 19 months after port implantation,respectively),and one child had the port removed as planned after completing chemotherapy.During use,complications included drug extravasation in two cases,CRBSI in two cases,and catheter thrombosis in one case.Ultrasound before port removal indicated varying degrees of fibrin sheath formation around the catheter in three cases.Conclusion TIVAP can meet the intravenous infusion needs of children undergoing chemotherapy.When used in accordance with standardized procedures,TIVAP are safe,offer significant advantages,and are highly practical.
作者
高鹏
吕秋晨
杨狄
张为伟
李志强
Gao Peng;Lyu Qiuchen;Yang Di;Zhang Weiwei;Li Zhiqiang(Department of Surgery,Heilongjiang Hospital Affiliated to Beijing Children's Hospital,Capital Medical University,Heilongjiang,Harbin 150010,China;Department of Ultrasound,Heilongjiang Hospital Affiliated to Beijing Children's Hospital,Capital Medical University,Heilongjiang,Harbin 150010,China;Department of Anesthesiology,Heilongjiang Hospital Affiliated to Beijing Children's Hospital,Capital Medical University,Heilongjiang,Harbin 150010,China;Department of Hematology,Heilongjiang Hospital Affiliated to Beijing Children's Hospital,Capital Medical University,Heilongjiang,Harbin 150010,China)
出处
《发育医学电子杂志》
2025年第4期287-292,共6页
Journal of Developmental Medicine (Electronic Version)
基金
黑龙江省卫生健康委员会科研课题(20220404131012)。
关键词
婴幼儿
完全植入式静脉输液港
超声辅助导管头端定位技术
白血病
Infant
Totally implantable venous access port
Ultrasound-assisted catheter tip positioning technology
Leukemia
