经皮腔内血管成形术在嵌顿的带涤纶套隧道型血液透析导管拔除并原位换管中的临床应用  

Clinical application of percutaneous transluminal balloon angioplasty for removal of the stuck cuffed catheter and re-catheterization

作　　者：王道洋[1] 马续祥 黄玉萍[1] 周玉叶[1] 卓丽 纵晓英[1] 王德光[3] WANG Dao-yang;MA Xu-xiang;HUANG Yu-ping;ZHOU Yu-ye;ZHUOLi;ZONG Xiao-ying;WANG De-guang(Department of Nephrology,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233040,China;Department of Nephrology,the People’s Hospital of Lingbi County,Suzhou 234200,China;Department of Nephrology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]蚌埠医学院第二附属医院肾脏内科,蚌埠233040 [2]灵璧县人民医院肾脏内科,宿州234200 [3]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《中国血液净化》2022年第12期924-928,共5页Chinese Journal of Blood Purification

基　　金：蚌埠医学院自然科学类项目(BYKF18119)。

摘　　要：目的探讨数字减影血管造影(digital subtraction angiography,DSA)引导下经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)辅助嵌顿的带涤纶套隧道型血液透析导管(tunneled cuffed catheter,TCC)拔除并原位更换的临床应用。方法收集蚌埠医学院第二附属医院肾内科2018年11月~2021年10月因颈内静脉TCC导管功能不良收治入院的11例MHD患者的临床资料。所有患者均是在更换带TCC导管过程中发现导管嵌顿,根据透析导管内径大小引入不同直径操作杆的球囊,对原TCC导管体内段全程扩张,松解纤维鞘后拔除嵌顿的透析导管,使用更大型号的球囊对纤维鞘进行后扩张,原位置入新的TCC导管。手术后随访5~35个月,观察TCC导管临床使用情况。结果PTA辅助拔管成功率100%,原位再置管成功率91%,所有TCC导管拔除及原位更换过程中均未发生心律失常、血管破裂损伤、血气胸、纵膈血肿及心包填塞等严重并发症;随访期间1例患者行肾移植,1例死于多发性骨髓瘤,透析导管血流量分别为200ml/min,240ml/min,其余患者TCC导管透析时血流量多在220~240ml/min。结论经皮腔内血管成形术辅助嵌顿带涤纶套隧道型血液透析导管拔除并原位更换新的带涤纶套隧道型血液透析导管,手术安全性及成功率较高,可作为处理带涤纶套隧道型血液透析导管嵌顿的首选方法。Objective To study the clinical application of percutaneous transluminal balloon angioplasty(PTA)for removal of the stuck cuffed catheter and re-catheterization in situ.Methods Clinical data of the 11 patients with stuck tunneled cuffed catheter in the Department of Nephrology,the Second Affiliated Hospital of Bengbu Medical College during the period between November 2018 and October 2021 were retrospectively analyzed.The stuck tunneled cuffed catheters in these patients were detected during the replacement of tunneled cuffed catheter when removal of the catheters by regular technique was impossible.According to the inner diameter of the tunneled cuffed catheter,balloons of various diameters on operating rod were imported to expand the whole length of the vessel in which the original dialysis catheter located.After release of the fibrin sheath,the stuck tunneled cuffed catheter was removed,and a larger balloon was used for further expansion of the fibrin sheath.A new tunneled cuffed catheter was then placed in situ.The clinical efficacy of the PTA operation was followed up for 5~35 months.Results The stuck cuffed catheters were removed following PTA in all 11 patients.A new cuffed catheter was successfully placed in situ in 10 patients.No operation-related complications occurred,including heart arrhythmia,central venous rupture,hemo-pneumothorax,mediastinal hematoma,cardiac tamponade and other complications.During the followed-up period,one patient underwent kidney transplantation,and one died of multiple myeloma;their blood access volumes were 200 and 240 ml/min.The blood access volumes were 220-240ml/min in other patients.Conclusion PTA for removal of the stuck cuffed catheter and replacement of a new cuffed catheter in situ is a safe and efficient operation,which should be recommended as the first choice for treatment of the stuck hemodialysis cuffed catheters.

关 键 词：嵌顿带涤纶套隧道型血液透析导管 经皮腔内血管成形术 再次置管 维持性血液透析 

分 类 号：R318.16[医药卫生—生物医学工程]