【摘要】目的探讨导丝硬头穿刺技术在血液透析相关上腔静脉闭塞再通术中应用的安全性及临床疗效。方法回顾性分析37 例血液透析相关上腔静脉闭塞并接受导丝硬头穿刺再通术患者的临床资料，37 例患者均接受上腔静脉再通并计划置入带隧道和涤纶套的透析导管(tunnel-cuffed catheter, TCC)。比较术前、术后TCC 导管血流量、尿素清除率(Kt/V)及尿素下降率(urea reduction ratio, URR)，统计手术技术成功率、围手术期严重并发症及术后3 个月TCC 相关并发症发生率。结果手术开通的技术成功率为91.9%(34/37)，围手术期严重并发症发生率为2.7%(1/37)。3 例患者未成功开通上腔静脉，其中2 例患者出现少量纵膈血肿经保守治疗后好转，1 例患者开通术中出现心包填塞，经心包穿刺引流后好转康复出院。术后TCC 导管血流量(t=- 3.669,P＜0.001)、Kt/V 值（t=- 9.170，P＜0.001）、URR(t= -7.673，P＜0.001)均优于术前，差异有统计学意义。术后3 个月随访患者未出现TCC 相关并发症。结论应用导丝硬头穿刺技术开通上腔静脉闭塞病变安全、有效，熟练、谨慎的手术操作是取得技术成功的关键。
【Abstract】Objective To investigate the safety and clinical efficacy of guidewire hard tip puncture technique in the treatment of hemodialysis related superior vena cava occlusion. Methods Clinical data of the 37 patients with hemodialysis-related superior vena cava occlusion and treated with guidewire hard tip puncture for recanalization were retrospectively analyzed. These patients underwent the operation of superior vena cava recanalization and tried to place tunnel-cuffed catheters (TCC). Preoperative and postoperative blood flow in TCC catheter, urea clearance (Kt/V) and urea reduction ratio (URR) were compared. Success rate of the surgical technique, perioperative severe complications and incidence of TCC-related complications were calculated after the operation for 3 months. Results The technical success rate of the surgical treatment was 91.9% (34/37). The rate of severe perioperative complications was 2.7% (1/37). Three patients failed to open the superior vena cava; two patients developed a small mediastinal hematoma and improved after conservative treatment; one patient experienced pericardial tamponade during endovascular manipulation and recovered after draining by pericardiocentesis. Postoperative blood flow in TCC, Kt/V value and urea reduction rate (URR) improved significantly as compared with those before operation. There were no TCC- related complications in the 3 months of follow-up period. Conclusions The guidewire hard tip puncture technology for recanalization of
the superior vena cava occlusion was safe and effective. Skilled and cautious surgical operation is the key to successfully rEopen the occlusion.
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