Fazlı YANIK, Yekta Altemur KARAMUSTAFAOĞLU, Yener YÖRÜK, Adem KARATAŞ

Tamamen implante edilebilir venöz port kateter deneyimi: 12 yılda 3000 hastanın analizi

Amaç: Bu çalışmada tamamen implante edilebilir venöz port kateter uygulanan hastalar ile deneyimimiz sunuldu. Çalışma planı: Mart 2005 - Mart 2017 tarihleri arasında tamamen implante edilebilir venöz port kateter uygulanan 3000 hastanın (1824 erkek, 1176 kadın; ort. yaş 61.04±11.5 yıl; dağılım, 18-88 yıl) demografik-klinik özellikleri, cerrahi sonuçları ve komplikasyonları retrospektif olarak değerlendirildi. Tamamen implante edilebilir venöz port kateter endikasyonları, komplikasyonları, kateter kalış süresi, kateter çıkarma nedenleri ve istatistiksel analiz bilgileri hasta kayıtları incelenerek detaylı bir şekilde sunuldu. Bulgular: Olguların %98’inde Seldinger yöntemi kullanıldı, %1’inde (n=36) kateter yüzeyel Doppler ultrasonografi ile takıldı, %1’inde (n=29) ise damar bulunamadı ve bu hastalar çalışmadan çıkarıldı. Tamamen implante edilebilir venöz port kateter 2095 hastada (%70) sağ internal jugüler ven yoluyla, 470 hastada (%16) sağ subklavvan ven yoluyla, 290 hastada (%10) sol internal jugüler ven yoluyla ve 106 hastada (%3) sol subklavyan ven yoluyla takıldı. Tamamen implante edilebilir venöz port kateter ortalama kalış süresi 46.7 ay (dağılım, 1-78 ay) idi. Toplam 288 hastada (%9.6), 153’ü (%5.1) erken ve 135’i (%4.5) geç olmak üzere komplikasyonlar tespit edildi. En sık görülen onkolojik endikasyon kolorektal kanser idi. Port çıkarma oranı 298/3000 (%9.9) idi ve başlıca nedenler enfeksiyon, tromboz, ağrı ve tedavinin sona ermesi idi. Tamamen implante edilebilir venöz port kateter 33 hastaya (%1) iki kez, 14 hastaya (%0.5) üç kez takılmak zorunda kalındı. Tamamen implante edilebilir venöz port kateter sekiz hastada malpozisyonlu idi ve bunların tamamı kılavuz tel yöntemiyle başarıyla revize edildi. Sonuç: Tamamen implante edilebilir venöz port kateter kanser hastalarında yaşam kalitesini artırabilir. Olası komplikasyonlara rağmen, tamamen implante edilebilir venöz port kateter uzun süreli intravenöz tedavi için güvenli ve konforludur. Tamamen implante edilebilir venöz port kateter yeterli deneyime sahip cerrahlarca uygulandığında olası komplikasyonlar önlenebilir veya yönetilebilir.

Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years

Background: This study aims to present our experience with patients who were performed totally implantable venous port catheter.Methods: Demographics-clinical features, surgical results and complications of 3,000 patients (1,824 males, 1,176 females; mean age 61.04±11.5 years; range, 18 to 88 years) who were performed totally implantable venous port catheter between March 2005 and March 2017 were evaluated retrospectively. Totally implantable venous port catheter indications, complications, catheter duration of stay, reasons for catheter removal and statistical analysis information were reported in detail by reviewing patient records.Results: Of the cases, the Seldinger method was used in 98%, 1% (n=36) had the catheter inserted with superficial Doppler ultrasonography, while the veins were not found in 1% (n=29) and these patients were excluded from the study. Totally implantable venous port catheter was inserted via right internal jugular vein in 2,095 patients (70%), via right subclavian vein in 470 patients (16%), via left internal jugular vein in 290 patients (10%), and via left subclavian vein in 106 patients (3%). Mean duration of stay for totally implantable venous port catheter was 46.7 months (range, 1 to 78 months). Complications were detected in a total of 288 patients (9.6%), 153 (5.1%) being early and 135 (4.5%) being late. The most common oncologic indication was colorectal cancer. The rate of port removal was 298/3,000 (9.9%) and the main reasons were infection, thrombosis, pain, and end of treatment. Totally implantable venous port catheter was required to be inserted twice in 33 patients (1%) and thrice in 14 patients (0.5%). Totally implantable venous port catheter had malposition in eight patients and all were revised successfully with over the guide method.Conclusion: Totally implantable venous port catheter may increase the quality of life in cancer patients. Despite possible complications, totally implantable venous port catheter is safe and comfortable for long-term intravenous treatment. Possible complications may be prevented or managed when totally implantable venous port catheter is performed by surgeons with adequate experience.

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