摘要
目的总结微创介入治疗在隧道式带涤纶套透析导管（TCC）嵌顿而拔除困难中的应用价值。方法选取2015年6月至2017年6月于四川大学华西医院就诊发现导管嵌顿的维持性血液透析（血透）患者，收集患者既往病史，完善术前检查，在X线引导下旋转拔除TCC，必要时经股静脉入路或原导管进行球囊辅助扩张、圈套器等手段拔除导管并更换TCC，记录手术及术中并发症情况。结果共纳入22例患者，平均年龄（67．2±18．5）岁，中位透析龄54（18，106）个月，导管留置时间为37（14，82）个月。所有患者均顺利拔除嵌顿导管，其中18例（81．8％）患者可见纤维蛋白鞘，13例患者的纤维蛋白鞘同时伴有钙化灶，导管嵌顿主要发生在颈内静脉下段汇人无名静脉处、右无名静脉中下段与上腔静脉中段。16例（72．7％）患者诉术中一过性胸骨后牵拉痛，1例患者出现腹股沟区血肿，无严重并发症发生。结论对于导管留置时间超过2～3年的维持性血透患者需要警惕导管嵌顿。x线引导下旋转牵拉联合球囊扩张等微创介入技术可安全有效地拔除嵌顿导管。
Objective To evaluate clinical value of interventional radiology in difficult extraction of stuck tunnel hemodialysis catheter （TCC）. Methods Maintenance hemodialysis patients who required removal of stuck TCC in our hospital from June 2015 to June 2017 were enrolled. Medical history and preoperative examinations were carefully evaluated. Patients were pulled rotationally the catheter under the fluoroscopy guidance and exchanged the TCC. The information and procedure-related complication were recorded. Balloon dilation or snare technique would be used when failed to remove the stuck catheter. Results A total of 22 patients were enrolled, with an average age of （67.2±18.5） years, a median dialysis time of 54（18, 106） months, and catheter indwelling time of 37（14, 82） months. All patients were successfully removed the stuck catheter, among which 18 cases （81.8%） had fibrin sheath and 13 cases with sheath calcification. TCC mainly stuck in the junction of internal jugular vein and innominate vein, middle and lower innominate vein and middle part of superior vena cava. No procedurerelated major complication occurred. Sixteen cases （72.7%） complained of transient substernal extraction pain and 1 case occurred groin hematoma during operation. Conclusions Catheter incarceration problem shouht be alert to the hemodialysis patients with catheter indwelling time of more than 2-3 years. The minimally invasive inierventional techniques including rolationally pull- out under fluoroscopy guidance and balloon angioplasly are safe. and effective in removal of the stuck TCC.
出处
《中华肾脏病杂志》
CSCD
北大核心
2017年第11期838-842,共5页
Chinese Journal of Nephrology
关键词
肾透析
血管通路装置
放射
介入性
导管嵌顿
Renal dialysis
Vascular access devices
Radiology, interventional
Stuck catheter
作者简介
通信作者：崔天蕾，Email：tianleicui@163．com
