肝胆恶性肿瘤患者中长期血管通路选择及使用专家共识

doi:10.3877/cma.j.issn.2095-3232.2026.02.001

肝胆恶性肿瘤患者往往需要接受系统性药物治疗或转化治疗等中长期治疗方案，且常合并肝硬化、脾功能亢进或胆道感染等基础病以及黄疸、腹水等并发症，增加了建立与维护血管通路过程中的复杂性和风险。目前的静脉通路指南尚不能完全满足肝胆恶性肿瘤治疗的临床需要，因此，上海东方肝胆外科医院静脉输液委员会组织共识委员会的多学科专家进行多次讨论，形成《肝胆恶性肿瘤患者中长期血管通路选择及使用专家共识》，旨在规范肝胆恶性肿瘤中长期血管通路的选择、植入、使用与维护全流程管理，提高治疗安全性和患者生存质量。

关键词: 肝胆恶性肿瘤, 血管通路, 中心静脉导管, 共识

Patients with hepatobiliary malignancies often need to receive medium to long-term treatment plans such as systemic or conversion therapy, and they are constantly complicated with underlying diseases such as liver cirrhosis, hypersplenism or biliary tract infection, as well as complications such as jaundice and ascites, which increase the complexity and risk in the process of establishing and maintaining the vascular access. The current intravenous access guidelines cannot fully meet the clinical needs for the treatment of hepatobiliary malignancies. Therefore, Intravenous Infusion Committee of Eastern Hepatobiliary Surgery Hospital organized multiple discussions among multidisciplinary experts of the Consensus Committee and formulated the "Expert consensus on the selection and use of medium to long-term vascular access in patients with hepatobiliary malignancies", aiming to standardize the full-process management of the selection, implantation, use and maintenance of medium to long-term vascular access for hepatobiliary malignancies, and to improve the safety of treatment and the quality of life of patients.

Key words: Hepatobiliary malignant tumors, Vascular access, Central venous catheter, Consensus

表1 GRADE证据质量与推荐强度分级

类别	具体描述
证据质量分级
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值, 但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级
强	明确显示干预措施利大于弊或弊大于利
弱	利弊不确定或无论质量高低的证据均显示利弊相当
GPS	基于非直接证据或专家意见/经验形成的推荐

表1 GRADE证据质量与推荐强度分级

类别	具体描述
证据质量分级
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值, 但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级
强	明确显示干预措施利大于弊或弊大于利
弱	利弊不确定或无论质量高低的证据均显示利弊相当
GPS	基于非直接证据或专家意见/经验形成的推荐

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[12]	中国康复医学会特殊环境作业损伤防治与康复专业委员会. 高原低压低氧环境下骨关节炎相关慢性继发性肌肉骨骼疼痛管理专家共识[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 665-672.
[13]	中国医师协会妇产科医师分会, 中国妇幼保健协会妇科智能医学专业委员会. 远程控制机器人辅助妇科手术中国专家共识(2025版)[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(05): 257-263.
[14]	中国医师协会结直肠肿瘤专业委员会, 中国医师协会结直肠肿瘤专业委员会微创解剖学组. 直肠癌微创精细解剖手术专家共识（2025版）[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 1-16.
[15]	脊髓电刺激治疗卒中后偏瘫中国专家共识编写组, 中华医学会神经外科学分会功能神经外科学组, 中国研究型医院学会神经外科学专业委员会, 世界华人神经外科协会功能神经外科专业委员会, 北京医学会神经外科学分会功能神经外科专业组, 北京医学会神经外科学分会周围神经外科专业组. 脊髓电刺激治疗卒中后偏瘫中国专家共识（2025年）[J/OL]. 中华脑科疾病与康复杂志(电子版), 2026, 16(01): 8-18.

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Expert consensus on the selection and use of medium- and long-term vascular access in patients with hepatobiliary malignancies

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Expert consensus on the selection and use of medium- and long-term vascular access in patients with hepatobiliary malignancies