星星叫（冯明）相关情况
冯明 男 1978年6月16日出生 汉族 广州人
Feng, Ming
Gender: Male
D.O.B: June 16th 1978
Nationality: China
People: Han
Residency: Guangzhou
主要病史
Main case history:
7个月左右 被发现患有 双肾母细胞瘤 作手术切除全部右肾及2/3左肾 手术成功 肾功能残余1/6 左1/3肾代偿良好
About 7 months old:
Wilm’s tumor (nephroblastoma) detected in both kidneys; the whole right kidney and two thirds of left kidney operated with nephrectomy. After this operation, only one sixth of the kidney function left; one third of the left kidney worked well.
童年 先后做过两次引睾手术
Childhood:
“Undescended testis”, operated twice;
1995年10月 开始出现浮肿 肾性高血压 慢性肾炎等症状入院保守治疗
October 1995:
Some symptoms occurred, including dropsy, kidney hypertension; chronic nephritic syndrome etc; treated in hospital.
1995年11月 急性阑尾手术切除 手术成功 但肾脏进一步损坏 需要进行透析治疗 于右锁骨下静脉插管进行透析 同时在左手肱动脉造瘘以长期透析 手术成功 瘘使用后插管拔除 但穿刺一直比较困难 需要专人定点穿刺
November 1995:
Acute appendicitis, operated successfully; but the kidney was further damaged; must be treated with hemodialysis: a catheter was plugged into the vein below the right clavicle for hemodialysis; meanwhile, a native av fistula was developed in the humerus artery of the left hand for long-term dialysis; the operation was successful; after the catheter was unplugged, the fistula worked well, but the piercing was always pretty tough, which needed assistance from specialists.
1998年8月 左手形成假性动脉瘤 手术切除成功 活检发现瘤为钙化纤维物质 瘘仍然能使用但左手开始逐渐浮肿不消
August 1998:
A pseudo-aneurysm found in left hand, which was operated successfully; the tumor was identified as calcified fibers; the fistula still worked but the renal edema on the left hand became worse
2004年8月 左手肿胀严重无法穿刺透析 于右颈内静脉插管进行透析 同时手术结扎左手的瘘 在右手肱动脉造瘘 手术后右手持续不消肿 后经造影检查发现右边锁骨下静脉狭窄导致回流障碍 于左颈内静脉插管进行透析
August 2004:
The renal edema on the left hand made the piercing-dialysis undoable; a catheter was plugged into the vein in the right neck for dialysis; the fistula in the left hand was ligated; another fistula was developed in the humerus artery in right hand; after the operation, the right hand swelled all the time; inspection figured that the narrowness of the vein below the right clavicle prevented the refluence of blood; a catheter was plugged into the vein in the left neck for dialysis
2005年11月 左颈静脉插管堵塞 于右颈静脉插管透析 同时在左大腿大隐静脉接股动脉造瘘 手术成功 结扎右手瘘 手术不成功 右手情况恶化
November 2005:
The catheter in the vein in the left neck got congested; the catheter was moved to right neck for dialysis; a traumatic arteriovenous fistula was developed at the intersection of the left thigh vein and left thigh artery; the operation was a success; however, the fistula in right hand was ligated unsuccessfully; right hand got even worse;
2006年3月 右手再次结扎手术 手术成功 尝试插管但不成功大腿瘘开始穿刺使用 疼痛异常 穿刺难度也很大
March 2006:
The fistula in right hand was ligated again; the operation was a success; a catheter was tried but not successful; the fistula on the left thigh was used for piercing-dialysis; the piercing was pretty touch and very painful;
2006年12月 左大腿形成假性动脉瘤并引发大出血 手术止血 手术成功但瘘被结扎 目前休养中 目前依靠右手动脉直接穿刺来透析 无法保证每次穿刺成功 一旦不成功将无法透析
December 2006:
Another pseudo-aneurysm found in left thigh, which resulted in massive haemorrhage; the haemorrhage was stopped but the fistula was ligated;
At present, the dialysis is conducted through direct piercing of the artery in right hand; the success of piercing cannot be guaranteed; once fails, the dialysis will be undoale.
主要问题
1）无法再造瘘 双手及左腿都已做过 右腿再做风险太大
2）插管困难 颈内静脉由于插过多次已产生疤痕狭窄 尝试过再插不成功 右边锁骨下静脉已知狭窄不行 左边锁骨下静脉离心脏太近 左股静脉已伤 右股静脉只可插临时管道 长期置管则无法达到足够长度且容易堵塞及感染 影响行动
Main issues:
1) Unable to develop native fistula: fistulae made on both arms and left leg but all failed; too risky to take the right leg;
2) Difficult to plug in the catheter: the vein inside the neck has been plugged so many times that it is too narrow to use, the vein below the right clavicle is also too narrow, the one under the left clavicle is too close to the heart. The vein in the left thigh is damaged; the one in the right thigh can only allow temporary catheter. Long-term catheter is not long enough and gets congested and infected easily, which will constraint the motion of the body.
主要求助
1）长期置管的手术技术及术后日常护理经验
2）长期置管的器材选择
Assistance needed in the following:
1) Operation techniques of long-term catheter implanting; experience of post-operation nursing;
2) Selection of long-term catheter types
说明：
1）本人腹部手术多 无完整腹膜 不能进行腹膜透析
2）群体抗体过高（PRA）无法进行肾移植配型
3）丙肝病毒携带者（HCV+）
4）一些数据；血色素长期为8-9克 现在手术后仅为7克左右；血压偏高 平均200-220/100-120（下肢） 药物控制效果不强 低于150/80就会晕厥；先锋4 先锋6过敏；酒精过敏；虾蟹过敏；（输液管过敏：此点最重要每次输液必须把管道内空气完全排空并用生理盐水清洗）
Notes:
1) The patient’s abdomen has been operated many times; the peritoneum is incomplete, therefore peritoneal dialysis cannot be conducted;
2) High PRA, matched kidney transplant operation is not suitable
3) HCV+ carrier
4) Some useful data: Long term heme protein is 8-9 grams; after operations, it falls to 7 grams approximately; blood pressure is high, on average 200-220/100-120 (lower limbs); medicine control doesn’t work well; if the blood pressure falls lower than 150/80, the patient will faint; allergic to Cefalexin and Cefradine; allergic to alcohol, shrimps and crabs; allergic to transfusion tube, which means before each transfusion, the air in the tube must be exhausted and the tube itself must be cleaned with physiologic brine;
acute appendicitis急性阑尾炎
chronic慢性
hemodialysis血透
aneurysm动脉瘤
（partial）nephrectomy （部分）肾切除术
nephroblastoma（Wilms’s tumor）肾母细胞瘤
renal edema 肾性水肿
traumatic arteriovenous损伤性动-静脉造瘘
冯明的博客
http://starscream.poco.cn/v2/
