透析导管置入过程中发现永存左上腔静脉并Chiari网嵌顿导丝1例  

A case report of guidewire entrapment in Chiari network involving persistent left superior vena cava

作　　者：胡蓉蓉[1] 王颖[1] 陈之淳 胡燕[1] 刘炳岩[1] 秦岩[1] Hu Rongrong;Wang Ying;Chen Zhichun;Hu Yan;Liu Bingyan;Qin Yan(Department of Nephrology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院肾内科,北京100730

出　　处：《中华肾脏病杂志》2023年第10期783-785,共3页Chinese Journal of Nephrology

摘　　要：该文报道1例尿毒症患者行透析导管置管过程中发现孤立性永存左上腔静脉(persistent left superior vena cava,PLSVC)并发生导丝嵌顿Chiari网现象。患者因终末期肾病、急性左心功能衰竭拟行急诊透析,行带隧道和涤纶套的透析导管(tunnel-cuffed catheter,TCC)置入,造影过程中发现孤立性PLSVC,操作导丝时发现右心房水平嵌顿,在操控导丝过程中导丝松动并带出一条细纤维丝,考虑为Chiari网嵌顿可能。1周后随访,患者透析导管使用良好,透析脱水后心功能改善。The article reports a rare case of isolated persistent left superior vena cava(PLSVC)found during the catheterization of a dialysis catheter in an end-stage renal disease patient and the occurrence of guidewire entrapment in Chiari net.The patient was scheduled to have emergency dialysis due to end-stage renal disease and acute left heart failure.And a tunnel-cuffed catheter(TCC)for dialysis insertion was planned.Isolated PLSVC was found firstly by the imaging process.Then the guidewire was entrapped at the right atrium in the further operation.During the operation of the guidewire,the guidewire loosened and withdrawn with a fine fiber,which was considered a possibility of Chiari net.In the follow-up after one week,the TCC worked well,and the heart function improved after dialysis.

关 键 词：肾透析 导管插入术 中心静脉 永存左上腔静脉畸形 带隧道和涤纶套的透析导管 导丝嵌顿 Chiari网 

分 类 号：R692.5[医药卫生—泌尿科学]