- 期刊
Transcatheter Retrieval of Dislodged Port-A Catheter Fragments: Experience with 47 Cases
經導管移除脫落人工靜脈血管(Port-A)斷片：47個個案之經驗分析
摘要
目的 觀察人工靜脈血管(Port-A)脫落之發生率及斷片最常見的位置，並統計經導管移除斷片之可行性及安全性。 方法 收集2005年1月至2006年3月，47位癌症患者因人工靜脈血管(Port-A)脫落而轉介到本院心臟科。所有患者均住院接受經導管移除脫落之人工靜脈血管斷片，且出院後持續追蹤至少一個月。本研究就人工靜脈血管斷片常見之脫落位置與移除之器械與手術方式加以分析討論。 結果 斷片最常見的位置為右心房到下腔靜脈之間(11/47)。四十六位患者(97.8%)成功地經導管移除斷片，只有一位病人失敗而必須接受外科手術。多數患者都能以常備器械（loop snares和pigtail catheters）來移除斷片。在我們的經驗裡，大部分較為複雜的器械如grasping forceps, baskets或flexible triple grasping forcep，在手術過程中並不會比loop snare易於使用，甚至可能會有血管破裂的危險。經導管移除脫落之人工靜脈血管斷片的後遺症很少(2/47)，只有一位血小板低下患者術後發生右鼠蹊部部血腫，另外一位患者在斷片移除過程中，三尖瓣有輕微的裂損。 結論 人工靜脈血管斷片最常見於右心房到下腔靜脈之間，經導管移除脫落之人工靜脈血管斷片，是技術上比較簡單、也比較沒有後遺症的方法。因此在處理脫落之人工靜脈血管斷片時，我們認為經導管移除方式是可行的及與安全的，可作為第一優先選擇的治療方式。
並列摘要
Objective: The purpose of the present study was to investigate the incidence and location of dislodged Port-A catheter fragments and the efficacy and safety of transcatheter retrieval of dislodged Port-A catheter in our hospital. Materials and Methods: Forty-seven cancer patients, mean age 56 years old with 53.2% male, were referred to our catheterization laboratory for retrieval of fractured Port-A catheter, were enrolled from January 2005 to March 2006. The procedures were performed under hospital guidelines and the patients followed in the outpatient department for at least 1 month after procedures. The characteristics of all fractured Port-A catheters were recorded. The procedure-related clinical status was evaluated. Results: The most common location of fractured catheter tip was found between the right atrium and inferior vena cava (11/47). Forty-six of the forty-seven (97.8%) dislodged catheters were successfully retrieval by the transcatheter method. Only one patient received surgical intervention because of failure to retrieve a dislodged catheter. Most of the procedures were performed with standard vascular tools (loop snares and pigtail catheters). In out experience, more sophisticated devices such as grasping forceps, baskets, or flexible triple grasping forceps have the drawback of limited valve compared to loop snare and even carry considerable risk of perforation. The complication rare of this procedure was fairly low (2/47, 4.3%), only one patient develop hematoma at right groin due to concomitant thrombocytopenia, and the other had flail of tricuspid valve damaged by a fragment passing though the valve. Conclusion: The most frequent location of dislodged Port-A catheter was found to situate between the right atria and inferior vane cave, where it was technically easier to be removed by the endovascular approach, with few complications reported. Therefore retrieval of dislodged Port-A catheters by endovascular approach might be the first choice of treatment because it is both safe and effective.