王宾; 肖恩华; 尚全良; 马聪; 陈柱; 罗建光; 朱晖; 张子曙

doi:10.3877/cma.j.issn.2095-5782.2018.02.010

点赞 0
分享 0
收藏 0
纠错

• 血管介入 •

经皮球囊血管成形术和经皮支架植入术治疗透析通路中心静脉狭窄的临床效果比较

中华介入放射学电子杂志, 2018,06(2) : 137-141. DOI: 10.3877/cma.j.issn.2095-5782.2018.02.010

摘要

目的：

观察透析通路中心静脉狭窄（CVS）经皮球囊血管成形术（PTA）和经皮支架植入术（PTS）治疗的近中期疗效。

方法：

选取2014年10月—2016年10月收治的发生CVS的血液透析患者40例，按治疗方式的不同分为PTA治疗组26例和PTA+PTS治疗组14例。观察两组患者术后疗效及通路管径变化情况；随访术后1、3、6个月透析通路的开放情况及开放时间。

结果：

术后相关症状均在1周内改善，治疗后通路直径较治疗前均增宽；PTA治疗组的初级开放时间为（5.17±1.54）个月，高于PTA+PTS治疗组的初级开放时间（3.57±1.71）个月；PTA+PTS治疗组的腔内干预次数为（1.93±0.47）次，高于PTA治疗组的（1.35±0.56）次，差异均有统计学意义。PTA治疗组1、3、6个月的初级开放率分别为96.2%、80.7%、69.2%，辅助初级开放率分别为100%、92.3%、92.3%；PTA+PTS治疗组1、3、6个月的初级开放率分别为92.9%、64.3%、14.3%，辅助初级开放率分别为100%、100%、85.7%。两组的初级开放率和辅助初级开放率差异无统计学意义。

结论：

透析通路CVS的治疗首选单纯PTA，当出现PTA抵抗或频繁复发时，可以考虑植入支架。

引用本文: 王宾, 肖恩华, 尚全良, 等. 经皮球囊血管成形术和经皮支架植入术治疗透析通路中心静脉狭窄的临床效果比较 [J/OL] . 中华介入放射学电子杂志, 2018, 06(2) : 137-141. DOI: 10.3877/cma.j.issn.2095-5782.2018.02.010.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

扫描看全文

正文

作者信息

基金 0 关键词 0

English Abstract

阅读 0 评论 0

相关资源

引用 | 论文 | 视频

除非特别申明，本刊刊出的所有文章不代表中华医学会和本刊编辑委员会的观点。

本刊为电子杂志，以光盘形式出版。本册应读者需求按需印刷，随光盘免费赠阅，光盘如有质量问题，请向编辑部调换

中心静脉狭窄（central venous stenosis，CVS）是肾衰患者透析通路较为常见的并发症，发生率达25%~40%^[1]。其中最常见的诱因为中心静脉导管的置入，可使其发生率增至50%^[2]。临床上有症状的CVS多表现为身体同侧肢体、胸壁或头颈面部水肿，俗称"肿胀手综合征"。以往对CVS的治疗多效果不佳且损伤较大，已不能满足临床治疗的需要。随着经皮球囊血管成形术（percutaneous transluminal balloon angioplasty，PTA）以及经皮支架植入术（percutaneous transluminal stenting，PTS）的发展，已逐渐成为治疗CVS的首选方法^[3]。但介入干预存在局限性，术后易复发，现今对于复发后继续进行PTA治疗还是PTS治疗仍存在争议，而且国内对于两种治疗方式疗效的对比少有报道。本研究搜集40例CVS患者，观察PTA及PTS的近中期疗效，以期为临床选择治疗策略提供帮助。

贡献者信息

王宾

410011　长沙，中南大学湘雅二医院放射科；570102　海南医学院第二附属医院放射科

肖恩华

410011　长沙，中南大学湘雅二医院放射科

尚全良

410011　长沙，中南大学湘雅二医院放射科

马聪

410011　长沙，中南大学湘雅二医院放射科

陈柱

410011　长沙，中南大学湘雅二医院放射科

罗建光

410011　长沙，中南大学湘雅二医院放射科

朱晖

410011　长沙，中南大学湘雅二医院放射科

张子曙

410011　长沙，中南大学湘雅二医院放射科

通信作者

肖恩华

410011　长沙，中南大学湘雅二医院放射科

Email：cjr.xiaoenhua@vip.163.com

关键词

中心静脉狭窄; 透析通路; 介入干预; 经皮球囊血管成形术; 经皮支架植入术;

作者声明

王宾，肖恩华，尚全良，等.经皮球囊血管成形术和经皮支架植入术治疗透析通路中心静脉狭窄的临床效果比较[J/CD].中华介入放射学电子杂志，2018，6（2）：137-141.

利益冲突

利益冲突：本研究过程和结果均未受到相关设备、材料、药品企业的影响。

历史

出版日期：2018-05-01

收稿日期：2017-11-26

本文编辑

闫娟

Vascular Intervention

Clinical effects comparison of percutaneous transluminal balloon angioplasty and percutaneous transluminal stenting in treatment of central venous stenosis of dialysis pathway

Bin Wang, Enhua Xiao, Quanliang Shang, Cong Ma, Zhu Chen, Jianguang Luo, Hui Zhu, Zishu Zhang

Published 2018-05-01

Cite as Chin J Inter Rad(Electronic Edition), 2018, 06(2): 137-141. DOI: 10.3877/cma.j.issn.2095-5782.2018.02.010

Abstract

Objective:

To observe the efficacy of percutaneous transluminal balloon angioplasty (PTA) and percutaneous transluminal stenting (PTS) in the treatment of central venous stenosis in hemodialysis patients.

Methods:

A total of 40 hemodialysis patients with central venous stenosis were admitted during the period from October 2014 to October 2016. According to the type of treatment, the patients were divided into PTA treatment group (n=26) and PTA+PTS treatment group (n=14) . The changes of the curative effect and the path of the two groups were observed, and the opening information and opening time of the 1, 3 and 6 months were followed up.

Results:

The related symptoms were improved within 1 week after operation, and the diameter of the access was wider after operation. The primary patency time with PTA group [ (5.17±1.54) months] was significantly higher than that with PTA+PTS group [ (3.57±1.71) months]; The number of intraluminal interventions in PTA+PTS group [ (1.93±0.47) times] was higher than that in PTA group [ (1.35±0.56) times], and the differences were statistically significant. The primary patency rates with PTA in 1, 3 and 6 months were 96.2%, 80.7% and 69.2%, respectively, and the assisted primary patency rates were 100%, 92.3% and 92.3%. The primary patency rates with PTA+PTS in 1, 3 and 6 months were 92.9%, 64.3% and 14.3% respectively, and the assisted primary patency rates were 100%, 100% and 85.7%. There was no significant difference between the two groups in primary patency rates and assisted primary patency rates.

Conclusions:

PTA is preferred in the treatment of central venous stenosis in hemodialysis patients. When PTA resistance or frequent relapse happened, stent placement should be considered.

Key words:

Central venous stenosis; Dialysis access; Endovascular treatment; Percutaneous transluminal balloon angioplasty; Percutaneous transluminal stenting

Contributor Information

Bin Wang