目的 探索一种处理纤维鞘的新方法以改善透析患者的血流量。 方法 6例无法建立动静脉内瘘并有多次多部位中心静脉导管留置史的维持性血液透析患者,经血管造影(Digital Substraction Angiography(DSA)证实存在导管相关纤维鞘。对纤维鞘行经皮腔内球囊扩张血管成形术(percutaneous transluminal angioplasty, PTA),然后经颈内静脉或股静脉途径置入长期中心静脉导管。 结果 术后应用导管透析,1例患者第2次透析时血流量为220ml/min,其余患者血流量均在250ml/min以上,随访2～6个月,所有患者均未出现导管功能不良及感染。 结论 球囊破坏纤维鞘可以改善导管的通畅性及血流量。

Objective To search for a new management technique to treat fibrin sheaths in tunneled dialysis catheters for the improvement of blood flow during hemodialysis. Methods We studied six maintenance hemodialysis patients, who were unable to create an arteriovenous fistula and had the history of central venous indwelling catheterizations at multiple sites. Digital subtraction angiography (DSA) confirmed the fibrin sheath formation in catheters. Percutaneous transluminal angioplasty (PTA) was then performed to disrupt the catheter sheath, followed by placement of an indwelling cuff-tunneled catheter via an internal jugular or femoral vein after successful angioplasty. Results The new catheters functioned well (blood flow rate >250 ml/ min) during hemodialysis in 5 cases, and the catheter could provide a blood flow of 220 ml/min in the second hemodialysis session in one case. No catheter dysfunction and infection were found in these cases in the following- up period of 2～6 months. Conclusion Balloon angioplasty to disrupt fibrin sheaths improved the patency of catheters and increased the blood flow during hemodialysis.