球囊扩张成形术在导管相关中心静脉病变再置管中的应用  

Application of percutaneous transluminal balloon dilatation in patients with catheter-related central vein disease

作　　者：何永春[1] 蒋华[1] 张萍[1] 雷欣[1] 陈涧扬 杨浩[1] 陈江华[1] He Yongchun;Jiang Hua;Zhang Ping;Lei Xin;Chen Jianyang;Yang Hao;Chen Jianghua(Kidney Disease Cen ter,the First Affiliated Hospital of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学附属第一医院肾脏病中心,杭州310003

出　　处：《中华肾脏病杂志》2019年第7期481-485,共5页Chinese Journal of Nephrology

摘　　要：目的探讨经皮球囊扩张腔内血管成形术(PTA)在导管相关中心静脉病变(CVD)再置透析导管中的临床疗效。方法回顾性分析浙江大学附属第一医院2015年1月至2018年3月收治的13例CVD患者的临床资料,所有患者经血管造影确定病变部位及导管嵌顿拔管失败原因。选择大小合适球囊扩张原导管腔内或狭窄部位腔内血管,并再置带涤纶套的透析导管。随访6个月观察PTA术后的临床疗效。结果13例患者中有4例在更换导管时发现导管嵌顿,经腔内球囊扩张术(HONG技术)后顺利拔管。13例患者PTA术后狭窄段血管内径均符合效果良好评价标准,并再置管成功。术后所有患者导管血流量>250ml/min。术后随访6个月,4例面部水肿患者中有3例面部水肿改善,1例改善不明显。10例患者导管血流量保持250ml/min以上,3例患者需口服华法令才可保持血流量>250ml/min。结论PTA术治疗CVD致导管嵌顿拔管失败及再置管困难的创伤小,患者耐受性好,拔管及再置管成功率高,能有效缓解中心静脉狭窄引起的临床症状。Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume >250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume >250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.

关 键 词：血管成形术 气囊 导管插入术 中心静脉 治疗结果 再置管 

分 类 号：R692.5[医药卫生—泌尿科学]