At the time of "the first line of life and death" in patients with uremia, the fourth hospital of Zhejiang University has successfully recovered the vitality

"Director Ding, I was diagnosed with a tough uremia patient today. I was infected with a moral fistula on the thighs. The groin was very swollen, and the situation was a bit heavy.

Some time ago, Ding Lei, deputy chief physician of the Department of Nephrology of the Fourth Hospital of Zhejiang University, received a call and rushed to the clinic. What kind of arterial fistula infection will cause outpatient doctors to worry so much? This also attracted Dr. Ding's attention.

Patient Zhang is from other provinces. He is a patient with uremia for many years. 8 months ago, he performed a "femoral-femoral vein artificial vascular bridge fistula" surgery 8 months ago. Fistula.

A dynamic fistula infection appeared before February. After a period of time, he consciously improved after the anti -infective treatment, and followed his son to Yiwu. He conducts hemodialysis every Wednesday in the outer hospital.

Patients with uremia have almost caused a disaster in neglecting the progress of the condition

The doctor of the nephrosis found that abnormal emergency operation surgery

After seeing Lao Zhang, Deputy Chief Physician Ding Lei checked it carefully. I saw a dark red bulge in the position of the groin on the left side, like a "hill", and the surface of the skin beating with the rhythm of the heart.

The ultrasonic examination found that the "hills" at the root of Lao Zhang's thighs are medical known as "pseudo -aneurysm". It is considered that the artificial blood vessels and autologous blood vessels are ruptured by the suture of the artificial vascular and autologous blood vessels caused by the original dynamic fistula. Blood has a hematoma formed by the tissue wrapped in the tissue of the blood vessels in the blood.

After admission, under the strict condition observation and monitoring, the aneurysm continued to progress. From the morning to 6 hours from the morning to the afternoon, the "hill" has become more tall, and the original dark red skin has become deeper The upcoming "little volcano".

The situation became increasingly critical, and Dr. Ding Lei immediately reported to the director of Yang Yi, director of the Department of Nephrology, "The patient was infected with pseudo -aneurysm, has skin necrosis, and develops quickly. The rupture is back to heaven. "

Director Yang Yi immediately decided the emergency surgery. At the same time, the tissue vascular surgery and anesthesiology department conducted major cases of discussions, and contacted the expert team of the expert team of the Zhejiang intravenous fistula blood vessels to remote consultation and jointly formulated the surgical plan.

When Lao Zhang was pushed into the operating room, the pseudo -aneurysm continued to progress rapidly, and the ischemia became more obvious. Blood will spray like the outbreak of the volcanic "magma". The external pressing hemostasis cannot work at all. In a second, it will cause blood loss shock, and the consequences will be unimaginable.

That night, Yang Yi, director of the Department of Nephrology of the Fourth Hospital of Zhejiang University, Deputy Chief Physician Ding Lei, Deputy Chief Physician of Yan Bo, Vascular Surgery Building, and director Xu Jianhong, director of the Department of Anesthesiology, struggled overnight to implement the emergency treatment for Lao Zhang Anesthesia resection and intravenous fistula repair surgery successfully resolved a "volcanic eruption" life crisis.

Open the "ulceration" in the blood vessels

The surgeon cleverly removed his own blood vessel "moving flowers and wood"

Faced with the "volcano" to be out of place, in the face of the "pseudo -aneurysm" that was eager to move, the surgical team took a step by step with rich surgical experience and technology.

During the operation, first found the deep arterial blood vessels on both sides of the pseudo -aneurysm, opened the huge aneurysm, removed thrombosis, and continued to block the intricate side branch blood vessels along the blood vessel veins.

Everything is conducted in an orderly manner. At this time, the worst situation of prediction before surgery appeared -surgical detection found that the trunk of the femoral artery and its branches had been rotten to a hole, and the defect was serious. The veins of the vein can be directly sutured and repaired, but the rotten artery cannot be sutured at all. What should I do?

Director Yang Yi said that at this time, other materials must be used, such as artificial materials for repairs, heterogeneous blood vessels or autologous blood vessels, considering serious infections in patients. In the plan, the surgery team staged a "moving flower and wood".

Experts from the Fourth Hospital of Zhejiang University Joint Vascular Surgery Experts. Under the escort of an expert and blood transfusion department, the original ulceration and fracture arterial blood vessels are removed, and a large hidden vein is taken out of the patient's thigh roots. Reinventing, successfully recovered the blood supply of Lao Zhang's lower limbs.

From the removal of the femoral arterial aneurysm, to the artificial blood vessels removed surgery, and then to the dynamic fistula repair surgery, this thrilling surgery ended from 9 pm to more than 2 am. The surgery was successfully completed! The patient was discharged smoothly one week after surgery.

Yang Yi, director of the Department of Nephrology of the Fourth Hospital of Zhejiang University, said that the operation is a difficult and critical operation, and few units in the province can be carried out independently. The preoperative surgery scheme, the perioperative period of various departments, and each step in the operation are treated with each step. They are complex and fine, which fully demonstrates the comprehensive technical level of the four disciplines of the fourth house of Zhejiang University. In the ranking of DRGS of kidney disease in Zhejiang Province, the internal formation of vascular cavity in the Department of Nephrology of the Fourth Hospital of Zhejiang University has ranked among the top five in the province, and the comprehensive strength is among the best.

How can patients with uremia protect dynamic venous fistula?

Suggestions from the Department of Nephrology

Dr. Ding Lei, the leader of the blood vessel pathway of the Fourth Hospital of Zhejiang University, said that patients with uremia need to be pulled out of their own blood during hemodialysis, and then returned to the body after being separated by the machine. In this process, in order to facilitate long -term dialysis patients' puncture and reduce the risk of infection, nephrologists often choose to establish an autologous intravenous fistula for patients to ensure that puncture veins can meet the blood flow requirements of dialysis during dialysis. Patients who cannot be an autologous intravenous fistula need to be a pedestrian -made vein intravenous fistula. Many patients with uremia will encounter situations similar to old Zhang. Dynamic fistula forms pseudo aneurysm due to secondary infections such as trauma and medical -based operations.

Dr. Ding Lei reminded that internal fistulas in the tramal fistula are the "lifeline" of our dialysis patients, which must attract high attention. The clinical situation of pseudo -aneurysm must be complicated and must be closely tracking and evaluating. Once secondary infections, skin necrosis, etc. As a result, severe consequences such as rupture of major bleeding, it is recommended that this type of patients discover the internal fistula murmur or the size of the internal fistula and the skin condition.

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