Santral Venöz Port İmplantasyonunda Sefalik ‘cut-down’ Yöntemi

Amaç: Bu çalışmada kliniğimzde sefalik ‘cut-down’ yöntemi kullanılarak yerleştirilen santral venöz port implantasyonunun cerrahi sonuçları değerlendirildi. Hastalar ve Yöntemler: Mart 2014 - Mart 2017 tarihleri arasında, Acıbadem Üniversitesi Tıp Fakültesi, Atakent Hastanesi, Göğüs Cerrahisi Servisi’nde sefalik ‘cut-down’ yöntemi ile venöz port implantasyonu uygulanan hastalar çalışmaya alındı. Altta yatan hastalıklar, ameliyat tekniği ve süresi ve perioperatif komplikasyonlar incelendi. Bulgular: Çalışmada toplam 263 hasta mevcuttu erkek = 137, kadın = 126, ortalama yaş = 51 yıl, dağılım = 18-89 yıl . Bu hastaların 250’ine sefalik ‘cut-down’ yöntemi ile venöz port takıldı başarı oranı: %95 . Sefalik ven kalibrasyonun yetersiz veya tromboflebitik olmasından dolayı diğer 13 hastada %5 işlem perkütan tamamlandı. 250 hastanın ortalama ameliyat süresi 33 dk dağılım; 22-65 dk idi. En sık altta yatan hastalık kolo-rektal kanserler idi. Sefalik ‘cut-down’ yöntemi ile venöz port takılan hastaların hiçbirinde ameliyat sırası komplikasyon izlenmedi. Perkütan yöntemle venöz port takılan bir hastada pnömotoraks gelişti. Tüp torakostomi gerekmedi. Postoperatif takipte 3 hastada %1.4 port yerinde kanama nedeniyle revizyon yapıldı. Sonuç: Sefalik ‘cut-down’ yöntemi ile venöz port takılması kolay uygulanabilen, güvenilir ve komplikasyon oranı düşük bir işlemdir. Pnömotoraks, hemotoraks veya büyük damar yaralanması gibi yaşamı tehdit eden potansiyel komplikasyonların nadir olması en önemli avantajıdır. Bu nedenle, hem hasta hem de sağlık çalışanları açısından kullanım kolaylığı nedeniyle tercih edilen bir işlemdir

Central Venous Port Implantation With Cephalic Vein ‘cut-Down' Method

Purpose: This study aimed to evaluate the postoperative outcomes of central venous port implantation using the cephalic ‘cut-down’ technique.Methods: This study was conducted between March 2014 and March 2017. The study population consisted of patients who underwent venous port implantation using the cephalic ‘cut-down’ technique at the Department of Thoracic Surgery, Acibadem University, Atakent Hospital. Underlying pathology, operative technique and time, and perioperative complications were analyzed. Results: This study included 263 patients male = 137, female = 126, mean age = 51 years, range: 18-89 years . Of these, 250 patients underwent venous port implantation via the cephalic ‘cut-down’ technique success rate: 95% . In the remaining 13 patients, the procedure was completed percutaneously due to the small caliber of the vein or thrombophelebitis. The mean operative time of the 250 patients was 33 mi. range, 22-65 min . The most common primary disease was colon cancer 34% . None of the patients undergoing the cephalic ‘cut-down’ technique had any intraoperative complications. One patient undergoing the percutaneous technique had pneumothorax. During postoperative follow-up, three patients 1.4% underwent bleeding control procedure due to port-side bleeding.Conclusion: Venous port implantation using the cephalic ‘cut-down’ technique is a safe, feasible procedure with a low complication rate. The rarity of its potential life-threatening complications such as pneumothorax, hemothorax and great vessel injury is an important advantage of this procedure. Therefore, It has become a preferred procedure by patients as well as health care providers

Keywords:

central venous catheter, cephalic vein, cut-down port implantation,

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