中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (08): 685-688.doi: 10.3969/j.issn.1671-4091.2025.08.013

• 血管通路 • 上一篇    下一篇

经皮原位隧道式带涤纶套透析导管的再置入

杨小华   崔天蕾   

  1. 610041 成都，1四川大学华西医院肾脏内科
    628000 广元，2川北医学院附属广元市中心医院肾病内科
  • 收稿日期:2025-01-09 修回日期:2025-05-30 出版日期:2025-08-12 发布日期:2025-08-12
  • 通讯作者: 崔天蕾 E-mail:tianleicui@163.com

Replacement of percutaneous in situ tunnel dialysis catheter with polyester sleeve

YANG Xiao-hua, CUI Tian-lei   

  1. Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China; 2Nephrology Department, Guangyuan Central Hospital Affiliated to North Sichuan Medical College, Guanyuan 628000, China
  • Received:2025-01-09 Revised:2025-05-30 Online:2025-08-12 Published:2025-08-12
  • Contact: 610041 成都，1四川大学华西医院肾脏内科 E-mail:tianleicui@163.com

摘要： 目的 评估经皮原位隧道式带涤纶套透析导管(tunnel cuffed central venous catheter，TCC)再置入技术的安全性、有效性。 方法 选取2023年1月─2024年12月四川大学华西医院肾脏内科收治符合条件的存留有原TCC皮下隧道需再次置入导管的血液透析患者。收集患者一般情况、血液透析情况、既往导管使用情况等信息。所有患者均尝试使用原TCC皮下隧道原位再置入导管，如未成功，则再穿刺后重新置入TCC。记录手术技术手段、手术时间、并发症、手术后导管使用情况等信息。 结果 共纳入53例患者，45例成功使用原皮下隧道置入导管，8例患者再穿刺成功后置入新导管。所有患者均顺利置入导管并使用，经原隧道原位置管成功率84.91%，手术时间较再穿刺置管患者减少(t=5.142,P=0.002)。手术后均无大出血、感染等手术并发症，手术后透析导管血流量为(233.77±17.23)ml/min。 结论 X线引导下，原位隧道式带涤纶套透析导管的再置入技术具有较高的安全性和有效性，在一定程度上缩短操作时间、降低手术难度，为长期透析血管通路的再建立提供了一条新的思路。

关键词: 血液透析, 血管通路, 隧道式带涤纶套透析导管

Abstract: Objective  To evaluate the safety and efficacy of a tunnel cuffed central venous catheter (TCC) re-implantation technique.  Methods  We recruited the hemodialysis patients who had subcutaneous TCC and needed to be replaced in the period from January 2023 to December 2024. General information of the patients, hemodialysis status, previous catheter use and other information were collected. Patients were tried to use the original subcutaneous tunnel to re-implant the catheter in situ. If this manipulation failed, TCC was re-implanted after re-puncture. Surgical techniques, operation time, complications, postoperative catheter use and other information were recorded.  Results  A total of 53 patients were included. TCC was successfully placed using the original subcutaneous tunnel in 45 patients, and was successfully placed after re-puncture in 8 patients. TCC was successfully replaced and used in all patients. The success rate of TCC replacement through the original tunnel was 84.91 %, and the operation time was less than that of re-puncture (t=5.142, P=0.002). There were no complications such as massive hemorrhage and infection after operation. The blood flow in dialysis catheter after operation was 233.77±17.23 ml/min.  Conclusions  Under the guidance of X-ray, the in situ re-placement of TCC with polyester sleeve is safe and effective, which shortens the operation time and reduces the difficulties of operation, and provides a new approach to re-establish the long-term dialysis vascular access.

Key words: Hemodialysis, Vascular access, Tunnel cuffed central venous catheter

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