Annals of urology & nephrology最新文献

英文中文

Intravesical Bacille Calmette-Guerin (BCG) Eradicates Bacteriuria in Antibiotic-Naïve Bladder Tumor Patients 膀胱内卡介苗根除Antibiotic-Naïve膀胱肿瘤患者的细菌尿

Annals of urology & nephrology

Pub Date : 2021-04-28 DOI: 10.33552/aun.2021.02.000548

Harry W Herr MD

Intravesical Mycobacterium bovis bacille Calmette-Guerin (BCG) is standard therapy for high grade noninvasive bladder cancer. BCG induces a robust immune response in the bladder, characterized by cytokine production, inflammation, and recruitment of immune cells [1]. Neoplastic cells slough in the urine as they are destroyed, leaving denuded mucosa in responding patients. Invading uropathogens trigger similar cellular responses that cause rapid shedding of infected bladder epithelial cells into the urine, known as exfoliation [2]. Bacteria can evade exfoliation by invading deeper epithelial cells and establish a reservoir for urinary tract infection [3]. Although contraindicated in acute cystitis, we have shown that BCG is safe and effective in patients with asymptomatic bacteriuria [4]. We hypothesized that the immune response to BCG may augment innate immune defenses to eradicate bacteriuria.

膀胱内牛分枝杆菌（BCG）是治疗高级别无创性癌症的标准疗法。BCG在膀胱中诱导强大的免疫反应，其特征是细胞因子的产生、炎症和免疫细胞的募集[1]。当新生细胞被破坏时，它们会在尿液中脱落，在有反应的患者中留下裸露的粘膜。侵入的尿路病原体会引发类似的细胞反应，导致受感染的膀胱上皮细胞迅速脱落到尿液中，称为脱落[2]。细菌可以通过入侵更深的上皮细胞来逃避脱落，并为尿路感染建立一个库[3]。尽管急性膀胱炎禁用BCG，但我们已经证明BCG对无症状菌尿患者是安全有效的[4]。我们假设对BCG的免疫反应可能增强先天免疫防御，以根除细菌尿。

引用次数: 0

Evaluation of Laser Therapy for Urgency Urinary Incontinence in Females 激光治疗女性急尿失禁疗效评价

Annals of urology & nephrology

Pub Date : 2021-04-06 DOI: 10.33552/aun.2021.02.000546

Ali Abid

Urgency urinary incontinence is a major health problem associated with detriments to the social, mental and economical spheres of an affected individual’s life. It is a symptom that is implicated in many syndromes such as overactive bladder, genitourinary syndrome of menopause and mixed urinary incontinence. The exact cause of urgency urinary incontinence has not been elucidated however some theories point to detrusor overactivity, poor bladder compliance and urothelial hypersensitivity as the culprits. The management of urgency urinary incontinence includes a stepwise approach beginning with behavioural and lifestyle modifications and physical therapy followed by pharmacological agents and then, for severe cases, surgical management. Laser therapy is a novel, non-hormonal, minimally invasive treatment approach that is rising in prominence in the literature. In this review an evaluation of the literature is conducted, appraising any relevant studies to determine if laser therapy is a viable management approach. Our finding is that at this current juncture there is not enough evidence to support the implementation of laser therapy for urgency urinary incontinence.

紧急性尿失禁是一个主要的健康问题，与受影响个人生活的社会、心理和经济领域的损害有关。这是一种与许多综合征有关的症状，如膀胱过度活动、更年期泌尿生殖系统综合征和混合性尿失禁。紧急性尿失禁的确切原因尚未阐明，但一些理论指出逼尿肌过度活动、膀胱顺应性差和尿路上皮过敏是罪魁祸首。紧急性尿失禁的治疗包括一种循序渐进的方法，从行为和生活方式的改变和物理治疗开始，然后是药物治疗，对于严重病例，再进行手术治疗。激光治疗是一种新颖的、非激素的、微创的治疗方法，在文献中越来越突出。在这篇综述中，对文献进行了评估，评估了任何相关研究，以确定激光治疗是否是一种可行的管理方法。我们的发现是，在目前的关键时刻，没有足够的证据支持激光治疗紧迫性尿失禁。

引用次数: 0

Challenges of Management of Duplex System Ureterocele in an 18-Year-Old Woman: A Case Report 一例18岁女性双系统输尿管膨出的治疗挑战

Annals of urology & nephrology

Pub Date : 2021-03-24 DOI: 10.33552/aun.2021.02.000547

A. Muhammad

Background: Ureterocele is a cystic dilatation of the intravesical part of the ureter. Duplex system ureterocele is rare and occur more in females. Patients usually present with recurrent abdominal pain and urinary tract infection. The diagnosis and the treatment of duplex system ureterocele in women may pose diagnostic and therapeutic dilemma. We report a case of duplex system ureterocele in a woman highlighting diagnostic and therapeutic challenges. Case report: This is 18-year-old woman who presented with recurrent right flank pain, intermittent fever of 7months duration and lower urinary tract symptoms. There was right renal angle tenderness on abdominal examination. Abdominopelvic ultrasound and computerized tomographic scan urogram (CTU) revealed right hydronephrosis and a ureterocele. Accurate diagnosis was missed by all the imaging studies done. She had excision of the ureterocele and common sheath reimplantation of the two ureters on account of duplex system ureterocele. She had uneventful recovery. The urethral catheter, stents, drain and the stitches were remove 15 and 16 days postoperatively. She was discharged 20 days post operatively. Conclusion: Duplex system ureterocele may present with recurrent pyelonephritis. Computerized tomographic scan urogram is necessary for accurate diagnosis. There may be diagnostic and or therapeutic challenges. Common sheath ureteral reimplantation is associated with good outcome.

背景：输尿管膨出是输尿管膀胱内部分的囊性扩张。双相系统输尿管囊肿是罕见的，多发于女性。患者通常表现为反复腹痛和尿路感染。女性双相系统输尿管囊肿的诊断和治疗可能会带来诊断和治疗难题。我们报告了一例女性双相系统输尿管囊肿，强调了诊断和治疗方面的挑战。病例报告：这是一名18岁的女性，表现为复发性右翼疼痛、持续7个月的间歇性发烧和下尿路症状。腹部检查发现右肾角压痛。腹部超声和计算机断层扫描尿路造影（CTU）显示右侧肾积水和输尿管囊肿。所有的影像学研究都未能准确诊断。由于双系统输尿管膨出，她切除了输尿管膨出并重新植入了两个输尿管的共同鞘管。她平安无事地康复了。术后15、16天取下导尿管、支架、引流管和缝线。她在术后20天出院。结论：复发性肾盂肾炎可出现双相系统输尿管膨出。计算机断层扫描尿路造影对准确诊断是必要的。可能存在诊断和/或治疗方面的挑战。常见的输尿管鞘管再植入术效果良好。

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引用次数: 0

Exstrophy Epispadias Complex: Outcome Analysis of Repair Performed at A Single Centre 复合体外翻:单中心修复的结果分析

Annals of urology & nephrology

Pub Date : 2021-03-24 DOI: 10.33552/aun.2021.02.000545

M. Arya

Objective: The exstrophy-epispadias complex (EEC) is a rare developmental defect which affects multiple systems including the genitourinary system. We share our outcome analysis of 34 surgeries performed on 27 EEC cases at our institution. Material and Methods: This is a retrospective analysis of the outcome and follow up of patients operated for EEC. A total of 27 cases including 15 bladder exstrophy (11 Males, 4 Females) and 19 epispadias (14 Males, 5 Females) were treated from September 2014 to November 2019. Total 34 surgeries were performed on 27 patients which included 7 male cases of closed exstrophy who underwent subsequent epidpadias repair. These included two interesting exstrophy cases also. One of them was a female bladder exstrophy reared as male up to 19 years and another a 31 years male with skin covered exstrophy, diphallia and total urinary incontinence since birth. Epispadias group also included two adult males. Result: Thirteen pediatric patients underwent primary bladder and abdominal closure. Bladder reclosure rate was 14.2%. One adult male underwent Mitrofanoff diversion. The other adult- 19 year female had bladder closure, followed by bladder augmentation and rectus flap interposition. Male epispadias repair was performed in 14 patients (7 post closed exstrophy and 7 epispadias). Fistula rate after male epispadias repair was 15.3%. Five females underwent repair for epispadias. Bladder neck reconstruction (BNR) was carried out in 6 patients. Continence rates post BNR was 83% (including social continence). This congenital anomaly requires accomplishment of meticulous repair in staged manner. These cases need follow up from birth to adulthood. Presentation at adult age is extremely rare and related to social stigma, illiteracy and poor access to health care system. and advancement meatal; CBE: Classical bladder exstrophy; CPRE: Complete primary repair of exstrophy; MSRE: Modern staged repair of exstrophy; VUR: Vesicoureteric reflux; SPCL: Suprapubic Cystoloithotomy; CIC: Clean intermittent catheterisation; IVU: Intravenous Urography; BSRI: Bem sex role inventory; SP: Suprapubic; GIDYQ-AA: Gender Identity/ Gender dysphoria questionnaire for adolescent and adults

目的：会阴外翻复合体（EEC）是一种罕见的发育缺陷，影响包括泌尿生殖系统在内的多个系统。我们分享了在我们机构对27例EEC病例进行的34次手术的结果分析。材料和方法：这是对EEC手术患者的结果和随访的回顾性分析。从2014年9月到2019年11月，共治疗了27例病例，包括15例膀胱膨出（11例男性，4例女性）和19例会阴炎（14例男性，5例女性）。共对27名患者进行了34次手术，其中包括7名男性闭合性外翻患者，他们随后接受了外足修复。其中还包括两个有趣的外翻病例。其中一例为女性膀胱膨出，以男性身份抚养至19岁，另一例为31岁男性，自出生以来就患有皮肤覆盖的膨出、双足畸形和完全性尿失禁。Epispadias组还包括两名成年男性。结果：13名儿童患者接受了原发性膀胱和腹部闭合术。膀胱闭合率为14.2%。1名成年男性接受Mitrofanoff分流。另一名19岁的成年女性接受了膀胱闭合术，随后进行了膀胱扩张术和直肌瓣间置术。对14例患者（7例闭合性外翻和7例会阴）进行了男性会阴修复。男性会阴修补术后瘘管发生率为15.3%，5名女性接受了会阴修补术。6例患者行膀胱颈重建术。BNR后的控制率为83%（包括社交控制）。这种先天性畸形需要分阶段进行细致的修复。这些病例需要从出生到成年进行随访。成年时出现的情况极为罕见，与社会耻辱、文盲和难以获得医疗保健系统有关。和肉的进步；CBE：经典膀胱外翻；CPRE：完成外翻的初级修复；MSRE：exstrophy的现代分期修复；VUR：膀胱输尿管反流；SPCL：肩胛上膀胱镜切除术；CIC：清洁间歇性导管；IVU：静脉尿路造影；BSRI：Bem性别角色清单；SP：肩胛上；GIDYQ-AA：青少年和成人的性别认同/性别焦虑问卷

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引用次数: 0

Does Intralesional Injection of Clostridium Histolyticum affect the Treatment Practice of Peyronie’s Disease? 病灶内注射溶组织梭菌是否影响佩罗尼病的治疗实践？

Annals of urology & nephrology

Pub Date : 2021-03-23 DOI: 10.33552/aun.2021.02.000544

I. Gruenwald

Introduction: Penile curvature and pain during erection present a significant bothersome issue for men with Peyronie’s disease and their partners. Clostridium histolyticum was approved for intralesional-injection in patients with Peyronie’s disease and penile curvature. Aim: We aimed primarily to determine whether the introduction of intralesional-injection of clostridium histolyticum affects the treatment pattern of Peyronie’s disease at a single academic medical center. Material and methods: Medical records of patients evaluated for penile curvature related to Peyronie’s disease were retrospectively reviewed. Patients were allocated into two groups: those who received consultation prior to intralesional-injection availability, and those who received consultation after intralesional-injection availability. Treatment choices were summarized as percentages of each group. Comparison between the groups regarding the proportion of patients who chose to undergo specific treatment was performed using a Chi-square test. Results: Two hundred and twenty-seven patients were evaluated. Fifty-nine were evaluated before the introduction of intralesional-injection of clostridium histolyticum (group A) while 168 patients were evaluated post-introduction of intralesional-injection of clostridium histolyticum (group B). After the first discussion on management, 32 (54.2%) group A and 105 (62.5%) group B patients decided not to pursue treatment nor follow-up. No statistically significant difference in percentage of patients undergoing any treatment was observed between the groups (p>0.05). Of the remaining 27 patients in group A, 10 patients (37.0%) underwent surgery. Of the 63 remaining patients in group B, 14 (22.2%) underwent surgery. No statistically significant difference in percentage of patients undergoing surgery was observed between the 2 groups. Of the remaining patients in group B, only 12 (19.0%) were treated with intralesional-injection of clostridium histolyticum, and the rest, thirty-seven (59%) patients, elected to continue follow-up without treatment. Conclusion: The addition of intralesional-injection of clostridium histolyticum to Peyronie’s disease treatment arsenal did not significantly alter the percentage of patients choosing to undergo surgery.

引言：阴茎弯曲和勃起过程中的疼痛对患有佩罗尼氏症的男性及其伴侣来说是一个非常麻烦的问题。溶组织梭菌被批准用于佩罗尼病和阴茎弯曲患者的病变内注射。目的：我们的主要目的是确定在单个学术医疗中心引入溶组织梭菌的病灶内注射是否会影响Peyronie病的治疗模式。材料和方法：回顾性分析与Peyronie病相关的阴茎弯曲评估患者的医疗记录。患者被分为两组：在病灶内注射可用性之前接受咨询的患者和在病灶内注入可用性之后接受咨询的人群。治疗选择总结为各组的百分比。使用卡方检验对两组选择接受特定治疗的患者比例进行比较。结果：对227例患者进行了评估。59例患者在引入溶组织梭菌病灶内注射前进行评估（A组），168例患者在引进溶组织梭菌病变内注射后进行评估（B组）。在第一次讨论管理后，32名（54.2%）A组和105名（62.5%）B组患者决定不进行治疗或随访。两组接受任何治疗的患者百分比没有统计学上的显著差异（p>0.05）。在A组其余27名患者中，10名患者（37.0%）接受了手术。在B组剩下的63名患者中，14名（22.2%）接受了手术。两组患者接受手术的百分比没有统计学上的显著差异。在B组的其余患者中，只有12名（19.0%）接受了病灶内注射溶组织梭菌的治疗，其余37名（59%）患者选择继续随访而不接受治疗。结论：在Peyronie疾病治疗库中加入溶组织梭菌病灶内注射并没有显著改变选择接受手术的患者比例。

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引用次数: 0

Congenital Pelvi-ureteric Junction Obstruction Associated with Crossing Lower Pole Vessels 先天性肾盂输尿管交界处梗阻伴下极血管交叉

Annals of urology & nephrology

Pub Date : 2021-02-23 DOI: 10.33552/aun.2021.02.000543

A. Muhammad

Background: Congenital pelvi-ureteric junction obstruction [PUJO] occurs when there is impairment of flow of urine from the renal pelvis to the proximal ureter due to inherited abnormalities of pelvi-ureteric junction [PUJ]. The presentation is usually at the 4 th or 5 th decade of life. It may rarely be associated with crossing lower pole vessel [CLPV]. Treatment is by Anderson- Hynes [dismembered] pyeloplasty which remove the abnormal PUJ and transposes the PUJ anterior to the offending vessels. I report a case of 45-year-old man with congenital PUJO associated with crossing lower pole vessel vessels who had dismembered Anderson -Hynes pyeloplasty. Case report: This is a 45-year-old man who presented with 4 years history of recurrent colicky left flank pain which was relieved by passing large volume of urine. The general examination was non remarkable. The left kidney was ballotable. The abdominopelvic computerized urogram revealed severe left hydronephrosis and hyperdense structure in the region of the left kidney. He had exploration via left Gibson incision with finding of multiple crossing lower pole vessels and aperistaltic segment at PUJ. He had excision of the abnormal PUJ, transposition of the crossing vessels posteriorly and dismembered Anderson-Hynes pyeloplasty. He had uneventful recovery and was discharged home 5 days postoperatively. Conclusion: Congenital PUJO associated with lower pole vessel is rare and may present in the 5 th decade of life. Anderson- Hynes dismembered pyeloplasty is the procedure of choice and associated with good outcome.

背景：先天性肾盂-输尿管交界处梗阻[PUJO]发生在由于先天性肾盂/输尿管交界处异常[PUJ]导致从肾盂到输尿管近端的尿液流动受损时。演讲通常是在人生的第4或第5个十年。它可能很少与穿越下极血管[CLPV]有关。治疗方法是Anderson-Hynes[肢解]肾盂成形术，切除异常的PUJ，并将PUJ转移到病变血管前方。我报告了一例45岁的男性先天性PUJO合并下极血管交叉，并对Anderson-Hynes肾盂成形术进行了肢解。病例报告：这是一名45岁的男性，有4年的复发性左腹绞痛病史，通过大量尿液缓解。一般检查并不显著。左肾可球囊扩张。腹盆电脑尿路造影显示严重的左肾积水和左肾区域的高密度结构。他通过左Gibson切口进行了探查，在PUJ处发现多个交叉下极血管和非周期性节段。他切除了异常的PUJ，后交叉血管移位，并肢解了Anderson-Hynes肾盂成形术。他恢复顺利，术后5天出院回家。结论：先天性PUJO合并下极血管是罕见的，可能在生命的第5个十年出现。Anderson-Hynes肢解肾盂成形术是一种可供选择的方法，且效果良好。

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引用次数: 0

Knowledge about Benefits of Kidney Transplantation: A Survey of Dialysis Patients. 关于肾移植益处的知识:对透析患者的调查。

Annals of urology & nephrology

Pub Date : 2021-01-01 Epub Date: 2021-05-13

Valerie Nwanji, Aria Ghahramani, Mujahed Dauleh, Nasrollah Ghahramani

Background: Knowledge about benefits of kidney transplantation (KT) is an important determinant of the patients' decision to pursue KT. We investigated factors associated with End Stage Renal Disease (ESRD) patients' knowledge about KT benefits.

Methods: We randomly invited 1,400 dialysis patients to complete a survey about benefits of KT. Using multivariate analysis, we calculated odds ratios for the probability of choosing the correct responses.

Results: Of 673 participants, 17.6% agreed with benefit of KT for older patients, 36.5% agreed with benefit of KT for diabetic patients, and 31.5% agreed with benefit of pre-emptive KT. Non-white (OR: 0.68) and older (OR: 0.65) participants were less likely to agree with the survival benefit of KT. Older participants were less likely to agree with benefit of KT for older (OR: 0.64), and diabetic patients (OR: 0.54). Participants with less than high school education were less likely to agree with benefit of pre-emptive KT (OR: 0.58). Participants with a previous KT were more likely to agree with benefit of KT for older (OR: 2.32), and diabetic patients (OR: 2.50), and with the benefit of pre-emptive KT (OR: 2.34). Participants who had received 3 or more modes of education about KT were more likely to agree with benefit of KT for diabetic patients (OR: 2.04), and with benefit of pre-emptive KT (OR:1.67).

Conclusions: Dialysis patients have limited knowledge about benefits of KT. Previous KT, exposure to 3 or more modes of KT education, and education attainment are significant contributors to knowledge about KT benefits.

背景:了解肾移植(KT)的益处是决定患者是否接受肾移植的重要因素。我们调查了与终末期肾病(ESRD)患者对KT益处的了解相关的因素。方法:随机抽取1400例透析患者进行KT获益调查。使用多变量分析，我们计算了选择正确答案的概率的比值比。结果:在673名参与者中，17.6%的人同意老年患者的KT获益，36.5%的人同意糖尿病患者的KT获益，31.5%的人同意先发制人的KT获益。非白人(OR: 0.68)和老年(OR: 0.65)参与者不太可能同意KT的生存益处。年龄较大的参与者不太可能同意KT对老年人(OR: 0.64)和糖尿病患者(OR: 0.54)的益处。低于高中教育程度的参与者不太可能同意先发制人的KT的好处(OR: 0.58)。先前有KT的参与者更有可能同意老年人(OR: 2.32)和糖尿病患者(OR: 2.50)的KT的益处，以及先发制人的KT的益处(OR: 2.34)。接受过3种或以上KT教育模式的参与者更倾向于同意糖尿病患者KT的益处(or: 2.04)和先发制人KT的益处(or:1.67)。结论:透析患者对KT的益处了解有限。有过KT经历、接受过3种或3种以上的KT教育模式以及受教育程度是影响KT收益的重要因素。

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引用次数: 0

A Rare Case of Peritoneal Loose Body (Mice) in Left Sided Inguinal Hernial Sac 罕见左侧腹股沟疝腹膜松脱体（小鼠）病例

Annals of urology & nephrology

Pub Date : 2020-12-23 DOI: 10.33552/aun.2020.02.000542

D. Patel

This work is licensed under Creative Commons Attribution 4.0 License AUN.MS.ID.000542. Abstract Background: Peritoneal loose bodies or peritoneal mice are calcified pieces of necrotic tissue found in the peritoneal cavity. They are usually asymptomatic and small, ranging from 0.5 to 1 cm in size, but rarely may be up to 5 to 10 cm in size [1]. Peritoneal loose bodies develop from Appendices epiploicae that has undergone axial rotation followed by necrosis of its pedicle and detachment. Peritoneal loose bodies are incidental finding at laparotomy [2] but they are rarely described in hernial sac in the literature. By this article I have attempted to describe the rare case report of this subject to add to the scarce literature on this subject Case report: One such loose body of 2*2 cm size was found intraoperatively in a 45-year-old male patient presented to civil hospital Ahmedabad with left sided inguinal hernia & operated at Civil Hospital, Ahmedabad in the indirect inguinal hernial sac. Left inguinal hernioplasty was done and excised sac with containing loose body was sent for histopathology which confirmed it to be a peritoneal loose body.

本作品采用知识共享署名4.0许可协议编号:ms . id .000542。背景:腹膜疏松体或腹膜小鼠是在腹腔内发现的坏死组织钙化块。它们通常无症状且体积小，大小为0.5至1cm，但很少可达5至10cm。腹膜疏松体由经轴向旋转后椎弓根坏死和脱离的尾阑尾发育而来。腹膜松散体是剖腹手术时偶然发现的，但在文献中很少在疝囊中发现。通过这篇文章，我试图描述这一主题的罕见病例报告，以补充关于这一主题的稀缺文献。病例报告:一名45岁男性患者因左侧腹股沟疝在艾哈迈达巴德民用医院术中发现2*2 cm大小的松体，并在艾哈迈达巴德民用医院进行手术，腹股沟斜疝囊。行左侧腹股沟疝成形术，切除含松体囊送组织病理学检查，证实为腹膜松体。

引用次数: 0

Iatrogenic Ureteral Transection During Suprapubic Cystolithotomy: A Rare Case Report 耻骨上膀胱取石术中医源性输尿管横断1例报告

Annals of urology & nephrology

Pub Date : 2020-12-22 DOI: 10.33552/aun.2020.02.000541

M. Arya

Primary vesical calculi are not uncommon in children in India. Percutaneous cystolithotomy (PCCL) or suprapubic cystolithotomy (SPCL) is the modality of treatment for large calculi owing to the small caliber of the urethra in children. Ureteral injury during SPCL is exceptional and unheard of. Herein, we report such a case with plausible reasons.

原发性膀胱结石在印度儿童中并不罕见。经皮膀胱镜取石术（PCCL）或耻骨上膀胱镜取石术（SPCL）是治疗儿童尿道小口径大结石的一种方法。SPCL期间的输尿管损伤是罕见的，也是闻所未闻的。在此，我们报告了这样一个有合理理由的案例。

引用次数: 0

Central Migration of Tunneled Dialysis Catheter into Right Ventricle causing Positional Superior Vena Cava Obstruction: A Case Report 隧道透析导管向右心室中心移位致位置性上腔静脉阻塞1例

Annals of urology & nephrology

Pub Date : 2020-12-16 DOI: 10.33552/aun.2020.02.000540

M. Sharif

Tunneled dialysis catheters placement under real-time ultrasound guidance using the internal jugular route is considered to be a relatively simple and straightforward procedure, though its insertion and maintenance are not entirely risk-free. A literature search is full of reports describing various complications dialysis catheters placement; however, a central displacement of the catheter months after insertion is not described in the past. This case report highlights a case of the central migration of tunneled dialysis catheters and emphasizes the importance of close monitoring of the position of these catheters.

使用颈内静脉通路在实时超声引导下放置隧道透析导管被认为是一种相对简单直接的程序，尽管其插入和维护并非完全没有风险。文献检索中充满了描述透析导管放置各种并发症的报告；然而，导管在插入后数月的中心位移在过去没有描述。本病例报告强调了一例隧道式透析导管中心迁移的病例，并强调了密切监测这些导管位置的重要性。

引用次数: 0

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