【摘要】目的探讨带隧道和涤纶套透析导管功能不良患者的评估和治疗策略。方法回顾分析上海中医药大学附属龙华医院血管外科2016 年1 月～2020 年12 月因带隧道和涤纶套透析导管功能不良收治的80 例病例的病例特点、治疗方法及疗效。结果本研究共纳入80 例患者92 次治疗，男31 例，女49 例，平均年龄(63.45±13.7)岁，造影显示75 例合并中心静脉病变。建立上肢自体动静脉瘘8 例，建立上肢人工血管动静脉瘘4 例，建立下肢人工血管动静脉瘘3 例，均正常使用。单纯溶栓治疗14 例22 次，平均通畅时间(10.22±9.62)月，其中2 例短期内再度导管功能不良而行原位换管。总计原位换管52 例，异位换管3 例，平均随访时间(49.5±3.8)月，导管12 个月、24 个月、36 个月通畅率分别为93.2%、82.7%、74.0%。结论对于带隧道和涤纶套透析导管功能不良的患者应在全面评估的基础上采用个体化的治疗方案，以延长患者的透析生命。
【Abstract】Objective To explore the evaluation and treatment strategies of tunneled cuffed catheter dysfunction in hemodialysis patients. Methods The characteristics, treatment methods and curative effects of 80 cases with tunneled cuffed catheter dysfunction treated in the Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine from January 2016 to December 2020 were retrospectively analyzed. Results Eighty patients totally subjected to 92 times of the treatment were enrolled in this study. Thirty-one were males and 49 were females. The average age was (63.45±13.7) years old. Radiography showed central venous stenosis in 75 cases. Autologous arteriovenous fistula was established in 8 cases, and arteriovenous graft was established in 4 cases in upper limb and in 3 cases in lower limb; all of the established fistulas were used normally. Thrombolytic therapy was used for 22 times in 14 cases, the average patency time was (10.22±9.62) months, and two of them had to change the catheter in situ because of recurrent catheter dysfunction in a short period of time. Fifty-two cases underwent catheter replacement in situ, and 3 cases underwent catheter replacement ectopically. The average follow-up time was (49.5±3.8) months. The patency rates were 93.2%, 82.7% and 74.0% after the treatment for 12 months, 24 months and 36 months respectively. Conclusion The treatment of tunneled cuffed catheter dysfunction should be individualized based on comprehensive evaluation of the patients so as to prolong the dialysis life of the patients.
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