| Objective: Through the comparison of two surgical methods of central and posterior approach to internal jugular vein,the advantages and disadvantages of central approach and posterior approach of internal jugular vein were discussed,the effect on the incidence of complications of long-term catheter patency provides a basis for reasonable surgical prevention and treatment of uremic patients.Methods: This study adopted a single-center,prospective,randomized,controlled experimental design.Uremic patients who meet the inclusion criteria who plan to undergo jugular long-term hemodialysis catheters from April 2018 to April 2019.Randomized grouping: Group A(30 cases)used the central approach to insert IJ catheters,and Group B(30 cases)used the posterior approach to insert IJ catheters;Follow up the catheterization during and after operation;from the basic data of patients(age,BMI,past medical history),preoperative examination index,peri-operative related index,including operation time,puncture success rate,blood loss,carotid artery injury,dialysis catheter curvature,postoperative patency rate,complications and postoperative dialysis,etc.,finally,the relevant parameters of the two surgical methods were statistically analyzed.Results: 1.A total of 60 uremic patients were scheduled toundergo long-term jugular hemodialysis catheter,including 35 males(58.3%)and 25 females(41.7%).The ratio of male to female was 7:5.The age of group A is 64.1 ±10.9 years old;the age of group B is 59.1±11.7 years old;the minimum age is 29 years old,the maximum age is 78 years old.2.The operation time of A and B groups were 11.5±2.1min and9.2±2.3min,The difference was statistically significant(p < 0.001).The bleeding volume of A and B groups were 6.52 ± 0.96 g and 6.42 ± 0.67 g.However,the data of group A and group B were not statistically significant.The incidence of difficult catheterization in group A and group B was 2 cases(6.67%)and 1 case(3.33%),respectively There was no significant difference between the two groups(P > 0.05).the incidence of misperforation of arteries(6.67%)in group A was higher than that in group B(3.33%),and the difference was not statistically significant(P>0.05);The success rate of catheterization in group B was higher than that in group A,but the difference was not statistically significant(P > 0.05).The hemodialysis blood flow in group B was slightly higher than that in group A.4.The corresponding angle of the curved arc of the catheter: group A was 136.33±15.54°;Group B was 118.53±16.92°,and the difference between the two groups was statistically significant(P < 0.001).When the neck is deflected to the left,the range of motion of the catheter:: 23.77°±9.36° in group A;Group B was 8.07°±5.09°,and the difference between the two groups was statistically significant(P < 0.001).The range of motion of the catheter when deflecting the neck to the right: group A was 9.13°±5.72°;Group B was 20.20°±6.89°,and thedifference between the two groups was statistically significant(P <0.001).5.3 months after operation,adverse events occurred in 1 case(3.33%)in the central approach catheterization group and 2 cases(6.67%)in the posterior approach catheterization group,and the difference was not statistically significant(P > 0.05).Six months after operation,adverse events occurred in 5 cases(16.67%)in the central approach catheterization group and 3 cases(10%)in the posterior approach catheterization group,and the difference was not statistically significant(P > 0.05).In the first year after operation,adverse events occurred in 12cases(42.86%)in the central approach catheterization group and 5 cases(17.85%)in the posterior approach catheterization group,the difference was statistically significant(P < 0.05).Conclusions: 1.The operation time of central approach group is longer than that of posterior approach approach group.2.There was no significant difference in operative blood loss,dialysis blood flow between the two methods.3.The bending degree of the catheter in the central approach group was larger than that in the posterior approach group,and the mobility of the catheter in the central approach group was larger than that in the posterior approach group when the head was deflected to the left,while it was greater in the posterior approach group when the head was deflected to the right.4.The incidence of long-term adverse events in the central catheterization group was higher than that in the posterior approach group. |
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