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題名 | In-Situ Transection of the Totally Implanted Venous Access System: A Case Report=皮下中央靜脈注射植入座導管中段折斷:病例報告 |
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作者姓名(中文) | 王定偉; 吳樹霖; 陳立明; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:4 民89.07-08 |
頁次 | 頁194-197 |
分類號 | 416.3 |
關鍵詞 | 皮下中央靜脈注射植入座; 導管中段折斷; Polyurethrane; Catheter; In-situ transection; |
語文 | 英文(English) |
中文摘要 | 皮下中央靜脈注射植入座發展至今約三十年,目前已廣為應用在需要化學治療或靜脈路徑難以建立之患者。與此皮下靜脈注射植入座有關之併發症也為醫師們所知曉。導管中段折斷是極為嚴重之併發症,至今文獻報告不超過二十例,且均為silicon材質。本篇報告--例以polyurethane為材質之導管折斷。Polyurethane有較強之材質韌性,故可做出較薄管壁之導管,文獻中只提過裂開而無折斷之情形,故仍需注意折斷的發生。發生的機率約0-2.8%。發生時,病患不一定有肩痛或胸痛的症狀,直到胸部X檢查才得知。折斷之位置均在鎖骨與第一肋骨間。可能之機轉為狹窄之骨間隙和強韌之鎖骨肋骨韌帶於肩關節運動時扯斷。避免此併發症之方法建議為較偏鎖骨外側進針,以獲得較寬之鎖骨肋骨間隙且讓導管能在血管腔內通過此間隙,而非管腔外,來避免外力的磨損。 |
英文摘要 | The totally implanted venous access system has been widely adopted in clinical practice for patients treated with chemotherapy, total parental nutrition and difficult venous route. In-situ transection is a rare complication but may cause disastrous results if not noticed. The incidence is about 0-2.8%. Except for breakage, there has been little discussion on polyurethane catheter fracture. We present a case about the implantation of the polyurethane tube device into a 78-year-old male patient with in-situ transection developed two months later. This may be due to an entrapment in the subclavius muscle-costoclavicular ligament complex, which binds or compresses the device during shoulder movements. This problem can be prevented by more lateral clavicle approaching subcalvian vein. If malfunction of the catheter is noticed, a chest film with contrast medium infusion should be obtained to rule out any breakage or fracture of the system. The "pinchoff" sign and the "fish mouth" deformity are early x-ray warnings for impending tear or transection. Immediate removal of the device is necessary when such are noticed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。