尿毒症上臂动静脉内瘘术后淋巴瘘一例

Lymphatic fistula in a uremia patient after arteriovenous fistula operation in the upper arm:a case report

动静脉内瘘是尿毒症患者长期维持血液透析治疗的血管通路,术后并发淋巴瘘少见。淋巴瘘是淋巴管受损引起的淋巴液外流,临床表现为术后早期伤口出现不能解释的包块或溢液。淋巴瘘常用的治疗方法为局部填塞、加压包扎,对于渗液量较大、压迫治疗无效的患者,可行手术治疗。该文报道了1例上臂动静脉内瘘术后并发淋巴瘘的尿毒症患者的诊治经过,该例经临床表现、体征结合漏液乳糜试验诊断为淋巴瘘。开始行淋巴瘘清创引流术,用局部加压包扎,效果欠佳,遂再行局部淋巴瘘腔探查引流术并局部使用50%葡萄糖液浸泡冲洗,术后予加压气囊加压包扎,同时联合阿托品肌内注射治疗,创面愈合,随访情况良好。

Arteriovenous fistula is a long-term vascular access for treatment of uremia patients in maintenance hemodialysis.The complication of lymphatic fistula after arteriovenous fistula operation is rare.Lymphatic fistula is lymphatic outflow caused by lymph-vessel impairment.The clinical manifestation is the mass or discharge of unknown cause appeared in early postoperative wound.Treatment commonly used for lym-phatic fistula is filling and compression , then it could use lymphatic ligation for those patients who had large volume of lymphatic fistula output and invalid compression therapy.Here we reported a case of treatment of lymphatic fistula in the upper arm of a uremia patient after arteriovenous fistula operation.The diagnosis of lym-phatic fistula was made according to the clinical manifestation , physical sign and leakage chyle test.The pa-tient started with drainage of the lymphatic fistula debridement surgery and local compression therapy which had poor effect, finally the incision healed by use of immersion with 50%glucose, compression bandage by com-pression air sac after local lymphatic fistula cavity exploration drainage surgery and combined with atropine in -jection treatment , follow-up evaluation was good.