摘要
背景与目的:完全植入式静脉给药装置(TIVAP)广泛应用于肿瘤患者的化疗、输血及营养支持治疗。其中,上臂输液港(UAP)因其避免发生胸腔并发症、切口隐蔽等优势,逐渐成为临床推荐方案。目前UAP主要有两种植入术式:隧道针-横切口术式与穿刺点-横切口术式。本研究旨在比较两种术式在血液肿瘤患者中的应用效果,评估其安全性与美观性,为临床术式选择提供依据。方法:回顾性分析2021年12月—2024年12月在中南大学湘雅医院接受UAP植入的412例血液肿瘤患者,根据术式不同分为隧道针-横切口组(n=200)和穿刺点-横切口组(n=212)。比较两组患者的术中指标(手术时间、术中疼痛评分、囊袋处导管打折率、术中出血量)及术后指标(术后并发症发生率、切口美观满意度)。结果:两组患者基线资料比较差异无统计学意义(均P>0.05),具有可比性。穿刺点-横切口组在手术时间[(32.99±4.91)min vs.(41.42±5.35)min]、导管打折率(1.4%vs.8.5%)、切口美观满意度评分(7.99±0.58 vs.6.26±0.86)方面均优于隧道针-横切口组(均P<0.05);穿刺点-横切口组术中出血量略高于隧道针-横切口组[(4.52±1.02)mL vs.(4.16±0.83)mL],差异虽有统计学意义,但其临床意义有限。术中疼痛评分及术后并发症发生率两组间差异均无统计学意义(均P>0.05)。结论:穿刺点-横切口术式在提高手术效率、减少导管打折及改善切口美观方面具有明显优势,且安全性不低于传统术式,具有良好的临床推广应用价值。
Background and Aims:Totally implantable venous access port(TIVAP)are widely used for chemotherapy,blood transfusion,and nutritional support in patients with malignancies.Among them,upper arm port(UAP)are increasingly recommended in clinical practice due to their advantages in avoiding thoracic complications and providing more concealed incisions.Currently,two main implantation techniques are used for UAP:the tunnel needle-transverse incision technique and the puncture point-transverse incision technique.This study aims to compare the clinical outcomes of these two techniques in patients with hematological malignancies,focusing on safety and cosmetic appearance,to provide evidence for clinical decision-making.Methods:A retrospective analysis was conducted on 412 patients with hematological malignancies who underwent UAP implantation at Xiangya Hospital of Central South University between December 2021 and December 2024.Based on the implantation method,patients were divided into the tunnel needle-transverse incision group(n=200)and the puncture point-transverse incision group(n=212).Intraoperative variables(operative time,intraoperative pain score,catheter kinking at the pocket,intraoperative blood loss)and postoperative indicators(incidence of complications and incision aesthetic satisfaction)were compared between the two groups.Results:There were no significant differences in baseline characteristics between the two groups(all P>0.05),indicating comparability.The puncture point-transverse incision group showed superior performance in operative time[(32.99±4.91)min vs.(41.42±5.35)min],catheter kinking rate(1.4%vs.8.5%),and incision aesthetic satisfaction(7.99±0.58 vs.6.26±0.86)compared with the tunnel needle-transverse incision group(all P<0.05).Although the puncture point group had slightly more intraoperative bleeding[(4.52±1.02)mL vs.(4.16±0.83)mL],the difference,while statistically significant,was of limited clinical relevance.No significant differences were observed between the two groups in intraoperative pain scores or incidence of postoperative complications(both P>0.05).Conclusion:The puncture point-transverse incision technique offers significant advantages in terms of operative efficiency,reduced catheter kinking,and improved incision aesthetics,without compromising safety.It represents a promising alternative to the traditional tunnel needle-transverse incision method and has strong potential for broader clinical adoption.The puncture point-transverse incision technique offers advantages such as shorter operative time,lower catheter kinking rate,and higher incision aesthetic satisfaction.It is a promising alternative to the traditional tunnel needle-transverse incision technique and has good potential for clinical application and promotion.
作者
刘琼
陈浩东
戴媛
丁小芳
罗旺辉
唐诗惠
陈焱
LIU Qiong;CHEN Haodong;DAI Yuan;DING Xiaofang;LUO Wanghui;TANG Shihui;CHEN Yan(Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国普通外科杂志》
北大核心
2025年第6期1188-1195,共8页
China Journal of General Surgery
基金
中国抗癌协会-恒瑞TPO受体激动剂研究基金资助项目(CORP-253)。
关键词
血管通路装置
上臂输液港
植入术式
血液肿瘤
Vascular Access Devices
Upper Arm Ports
Implantation Techniques
Hematologic Neoplasms
