血液透析中经腰腔静脉置管与经股静脉置管比较  

Translumbar vena cava catheterization versus transfemoral vein catheterization in hemodialysis

作　　者：丁文金 马聪[2] DING Wenjin;MA Cong(Department of Vascular Intervention,Xiangxi Tujia and Miao Autonomous Prefecture People's Hospital,Hunan Province 416000,China)

机构地区：[1]湘西土家族苗族自治州人民医院介入血管科,湖南湘西416000 [2]中南大学湘雅二医院放射介入科

出　　处：《介入放射学杂志》2024年第6期659-663,共5页Journal of Interventional Radiology

摘　　要：目的比较经腰腔静脉置管(TLC)与经股静脉置管(FVC)方式植入长期透析管方案的差异。方法回顾性分析2015年6月至2020年6月在湘西土家族苗族自治州人民医院接受FVC(159例)、TLC(29例)建立血管通路患者临床资料。采用统计学方法比较两组手术成功率、术中及术后相关并发症发生率。结果TLC组、FVC组手术成功率比较差异无统计学意义(97.06%比97.85%,P=0.770)。TLC组、FVC组术后1、2、3年累计一期透析导管通畅率分别为89.75%、81.40%、30.65%,86.25%、60.9%、28.21%,差异无统计学意义(均P>0.05)。两组患者间围手术期、早期及晚期置管相关并发症比较差异无统计学意义(均P>0.05),机械性并发症比较差异无统计学意义(P>0.05)。TLC组导管相关感染发生率低于FVC组(12.13%比32.42%,P<0.05),血栓发生率低于FVC组(3.03%比17.03%,P<0.05)。结论TLC手术成功率高,导管相关感染发生率低于FVC。具备手术条件的临床中心面对常规静脉通路耗竭患者选择透析通路时,TLC可能是更优选择。Objective To compare the surgical success rate and postoperative complications of translumbar vena cava catheterization(TLC)and transfemoral vein catheterization(FVC)in implanting the longterm dialysis catheter.Methods The clinical data of 159 patients who received FVC(FVC group)and 29 patients who received TLC(TLC group)for establishing vascular access at the Xiangxi Tujia and Miao Autonomous Prefecture People's Hospital of China between June 2015 and June 2020 were retrospectively analyzed.Using statistical methods,the surgical success rate and the incidence of intraoperative and postoperative complications were compared between the two groups.Results There was no statistically significant difference in the surgical success rate between TLC group and FVC group(97.06%vs.97.85%,P=0.770).The postoperative one-,2-and3-year cumulative primary dialysis catheter patency rates in the TLC group were 89.75%,81.40%and 30.65%respectively,which in the FVC group were 86.25%,60.9%and 28.21%respectively,the differences between the two groups were not statistically significant(all P>0.05).No statistically significant differences in the incidences of perioperative,early,and late catheterization-related complications existed between the two groups(all P>0.05).There was no significant differences in the incidences of mechanical complications between the two groups(all P>0.05).The incidence of catheter-related infection in the TLC group was lower than that in the FVC group(12.13%vs.32.42%,P<0.05),and the incidence of thrombus in the TLC group was also lower than that in the FVC group(3.03%vs.17.03%,P<0.05).Conclusion TLC carries a higher surgical success rate and its incidence of catheter-related infection is remarkably lower than that of FVC.In a clinical center where sufficient surgical conditions are available,TLC may be the optimal option for the patients whose conventional venous access routes have been depleted.

关 键 词：血液透析 中心静脉导管 经腰腔静脉置管 经股静脉置管 术后并发症 

分 类 号：R692.5[医药卫生—泌尿科学]