醫院的植入式中央靜脈注射埠port A ( Port-A-cath ) 是個大宗的業務
這個小小的東西一般用來提供病人化療藥物注射, 國外還可以用來給需要長期治療的病人
例如感染性心內膜炎需點滴注射抗生素四至六週以上
短腸症的病人需長期使用靜脈營養可能要一輩子每天打針
用來注射抗生素抗病毒藥劑營養針甚至輸血都很方便
特殊的型號的port 還可以拿來注射顯影劑
當然最多的還是用來做化療
以前別科還會會診心臟外科作這個小手術的時候
一個月總有超過五十個病人接受這個手術
也代表每個月我們醫院可能出現了超過五十位新的癌症患者
實在令人心驚
裡面有新發現的鼻煙癌, 乳癌, 血癌, 淋巴癌, 食道癌, 肺癌或者術後復發轉移的各式癌症
或者開完刀嚴重淋巴轉移可能開刀無法確保完全乾淨的的的胃癌, 大腸癌,肝癌, 胰臟癌, 腦癌,
骨癌, 子宮內膜癌, 卵巢癌...
所以光是幫這些滿臉愁思的病人及家屬做妥善的術前術後講解各種化療用的管路選擇的優缺點
實在是個痛苦差事
...
一般常見的化學治療注射管路有兩種
一種是植入式的一種是外露式的
植入式就是一般簡稱為 port A 的注射埠
外露式的就是PICC 從周邊插入的中央靜脈管一般指手肘上下擺進上腔靜脈中的化療注射管
有一條細細的注射接頭露在皮膚外面
使用時不需以特殊針頭扎進皮膚中
只需將點滴頭接在注射接頭上就可以了
病人省掉每次扎針的疼痛感也不用擔心點滴液外漏在皮下或者管路斷裂氣體栓塞等等併發症
可是外露式的PICC 由於需要患者每日自行照顧管路消毒以及防止洗澡濺濕傷口等麻煩事
在我們醫院不太受到患者以及醫師歡迎
有一陣子幾乎病人全部選擇放在鎖骨下或者說前胸的chest port
大約從2009年開始
美國一些醫學中心開始嘗試使用可以埋在上臂或者手肘附近比傳統port A 小了一半的
植入式port
簡稱為arm port
當然在做這類的建議給病人時他們會自行詢問其他病友的意見
這是其中一個癌友支持團體的問答
Q: ( 化療護士及醫師請她決定要擺在胸口或者手臂...)
I have to get a port put in this week. I assumed I would get it in the chest. However my chemo nurse said that some of her patients have recently had one put in their uppper arm. In the arim has to be done my a surgeon. Anyone have this type and what's your opinion of it. I need to make up my mind this week and have it put in since they are holding up my avastin a few weeks so it can heal up. Thanks,
A1: ( 擺在手臂, 萬分喜愛, 大寫 )
I've had mine in my upper arm now for years and LOVE IT!! It's much more comfortable than in the chest, it is much more easily accessible, and all of the nurses at my Onc's office absolutely LOVE IT!! They love it, I believe, because it ALWAYS works, and it is SO MUCH more easily accessible. This is the "new way" of implanting ports (I participated in a clinical trial of putting them in the upper arm when I had mine done) and even though I travel about 2 1/2 hours to get my Onc's office, they are now referring their patients to here to have their port put into their upper arm.
It is maybe 2" below my shoulder, slightly more toward the inner part of the arm. It connects into my jugular vein in the neck and then down from there.
I VERY HIGHLY recommend it!
A2: ( 想要在手臂不要在前胸影響胸罩背帶, 可是外科還是擺在前胸, 嗚)
I would much rather have mine in my arm. They can make that a powerport - then they can use it for scans that they can't use a regular port for. Also - my chest port is right where my bra strap would lie so I haven't been able to wear a bra since I had it put in. I say...arm all the way! BY the way - a surg. put my chest port in with twilight anesthesia.
A3: （ 病人放arm port的一場悲劇...)
I had mine placed just below the elbow and I loved it as well....couldnt even really see it...I was very well pleased....However, one day I lifted my 30 lb daughter and the catheter that goes up your arm to the heart, got ripped out of my heart and wound down in my arm...kinda painful and immediate surgery to remove it....This surgeon is awesome and he said he has placed thousands....He does lots of kids/teens with cancer and they lift weights, play baseball etc and he has never seen this happen....I believe him but no more ports there for me....So he put a power port back in my opposite chest...1st on was on rt, then rt arm now left chest *cancer side*.....so now i have some mild lymphadema in that arm....so wished it had worked in my arm....I really loved it and felt so less invaded, having drugs going thru arm not chest....but my new one works the best of all so am thankful for that. I would go for it....
A4: ( 病人擺了arm port, 擔心影響健身房運動..)
I had a Bard Powerport placed in my left inside upper arm in October and have been very happy with it. It's much smaller than the traditional chest port and the scar is usually not visible as it's on the inside of my arm.
As I was being wheeled into the operating room, the nurse told me I could never lift more than 10 lbs with that arm. I told her I was very active and she said "you gotta roll with the punches!" Now that I'm working out again, I called Bard to find out exactly what I can and cannot do. They were very conservative and advised against lifting any kind of weight over 5 lbs, doing yoga poses that put weight on the arm, and doing any kind of repetitive arm movements. As you can imagine, I was not happy as that would rule out many if not all forms of exercise. I spoke with my oncologist and he, like I, believe that they were being overly cautious. At the same time, we've heard from momX4TNBC that dislodged her catheter by lifting her daughter (30 lbs). The folks from Bard warned of dislodging the catheter and/or causing a blood clot from the catheter moving up and down inside the vein with repetitive movements.
I have begun exercising again and do modify certain activities. One day in a gym class, we did many biceps curls and my arm was a little sore right where the catheter might be.
So, overall, I'm very happy with my arm port but would speak with your doctor concerning lifting (lbs) and exercise. This is a risk with every procedure we endure. For me, not having to look at another scar everytime i look in the mirror was important. I'll continue to be gentle with my arm port and hope it continues to be good to me :)
大體上可以嗅出 親身經歷的病人覺得arm port 的好處是
1. 傷口小幾乎看不到疤痕
2. 不影響胸罩背帶穿著造成不舒服
3. 打針容易打
4. 注射藥劑時心理壓力比較小...
壞處就是
1. 可能不能提重物包括一把抓起三十磅重的小女兒
2. 可能會斷裂管路溜進心臟
3. 影響愛好運動者的選擇項目...
所以同樣的
在我們正式申請開始做這個擺在手臂的化療注射埠arm port
我們的考慮是
1. 會不會跟PICC 一樣增加血栓靜脈炎的機會
2. 會不會管路容易阻塞感染或者造成皮膚張力過大容易磨破皮膚或者造成穿著衣物的不便
3. 會不會因為管路小藥劑注射時的幫浦壓力很大, 機器會時常叫
4. 其他醫學中心的經驗呢??和信???還是國外大型癌症中心????
...( 待續)
