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经隧道式管路腔内成形术（TuLIP）：挽救纤维蛋白鞘形成时血液透析导管通畅性的一种替代技术。

TuLIP (Tunnelled Line Intraluminal Plasty): An Alternative Technique for Salvaging Haemodialysis Catheter Patency in Fibrin Sheath Formation.

作者信息

Ahmed R, Chapman S A, Tantrige P, Hussain A, Johnston E W, Fang C, Ammar T, Huang D Y, Wilkins C J, Garzillo G, Yusuf G T

机构信息

Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.

出版信息

Cardiovasc Intervent Radiol. 2019 May;42(5):770-774. doi: 10.1007/s00270-019-02189-7. Epub 2019 Mar 1.

DOI:10.1007/s00270-019-02189-7
PMID:30824945
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6435624/
Abstract

BACKGROUND

Renal patients with a tunnelled haemodialysis line are at risk of fibrin 'sheath' formation which can lead to occlusion. Dysfunctional lines are best treated by catheter exchange with a new subcutaneous tunnel; however, there is a risk of scarring, venous stenosis, potential loss of valuable access as well as the risk of infection.

METHOD

We report a retrospective review of our experience using tunnelled line intraluminal plasty (TuLIP) in 11 patients over 16 months with fibrin sheath formation on pre-existing tunnelled haemodialysis catheters.

RESULT

All patients responded well to treatment with median line patency post TuLIP reaching 112 days.

CONCLUSION

TuLIP may have a role in extending catheter lifespan and delaying more invasive intervention.

摘要

背景

带有隧道式血液透析导管的肾病患者存在形成纤维蛋白“鞘”的风险，这可能导致导管堵塞。功能失调的导管最好通过更换新的皮下隧道导管来治疗；然而，存在瘢痕形成、静脉狭窄、可能失去宝贵的血管通路以及感染风险。

方法

我们报告了一项回顾性研究，总结了我们在16个月内对11例在已有的隧道式血液透析导管上形成纤维蛋白鞘的患者使用隧道式导管腔内血管成形术（TuLIP）的经验。

结果

所有患者对治疗反应良好，TuLIP术后导管通畅的中位时间达到112天。

结论

TuLIP可能在延长导管使用寿命和推迟更具侵入性的干预方面发挥作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/c98f4d88cdd1/270_2019_2189_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/43ebc7a226cc/270_2019_2189_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/d903a48c2c9c/270_2019_2189_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/961f726b9cf3/270_2019_2189_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/c98f4d88cdd1/270_2019_2189_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/43ebc7a226cc/270_2019_2189_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/d903a48c2c9c/270_2019_2189_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/961f726b9cf3/270_2019_2189_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec90/6435624/c98f4d88cdd1/270_2019_2189_Fig4_HTML.jpg

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本文引用的文献

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Cochrane Database Syst Rev. 2017 Oct 26;10(10):CD011953. doi: 10.1002/14651858.CD011953.pub2.
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Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis.中心静脉端口导管中的纤维蛋白鞘：门诊低剂量单次注射尿激酶治疗
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透析导管功能的优化。
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Fibrin sheath formation and intimal thickening after catheter placement in dog model: role of hemodynamic wall shear stress.犬模型中导管置入后纤维蛋白鞘形成和内膜增厚：血流动力学壁面剪应力的作用
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Dialysis catheter fibrin sheath stripping: a useful technique after failed catheter exchange.透析导管纤维蛋白鞘剥除术：导管更换失败后的一种有用技术。
Biomed Imaging Interv J. 2012 Jan;8(1):e8. doi: 10.2349/biij.8.1.e8. Epub 2012 Jan 1.
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Balloon angioplasty for disruption of tunneled dialysis catheter fibrin sheath.用于破坏隧道式透析导管纤维蛋白鞘的球囊血管成形术。
J Vasc Access. 2012 Jan-Mar;13(1):111-4. doi: 10.5301/jva.5000015.
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Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis.经皮腔内血管成形术球囊破坏纤维鞘与迟发性中心静脉狭窄的关系。
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Catheter patency and function after catheter sheath disruption: a pilot study.导管鞘破裂后导管的通畅性和功能：一项初步研究。
Clin J Am Soc Nephrol. 2007 Nov;2(6):1201-6. doi: 10.2215/CJN.01910507. Epub 2007 Oct 17.
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