维持性肾透析伴中心静脉狭窄的介入治疗  

Interventional treatment of maintenance hemodialysis patients with central venous stenosis

作　　者：付志刚[1] 李勋 田杰 蔡飞 赵文江[1] 张晓磷[1] FU Zhigang;LI Xun;TIAN Jie;CAI Fei;ZHAO Wenjiang;ZHANG Xiaolin(Department of Radiology,Yichang Central People's Hospital,Yichang 443003,China;Department of Radiology,Dangyang People's Hospital,Dangyang,Hubei Province 444100,China)

机构地区：[1]宜昌市中心人民医院放射科,湖北宜昌443003 [2]当阳市人民医院放射科,湖北当阳444100

出　　处：《实用放射学杂志》2020年第3期456-459,共4页Journal of Practical Radiology

摘　　要：目的探讨维持性肾透析(MHD)伴中心静脉狭窄(CVS)患者血管腔内介入治疗的临床疗效。方法选取MHD伴CVS患者18例,所有患者均有不同程度中心静脉回流障碍相关症状。所有责任中心静脉采取介入治疗,术后随访并观察患者临床症状变化、中心静脉通畅情况。结果18例患者介入术后中心静脉全部开通,静脉回流障碍相关症状消失。经皮球囊血管成形术(PTA)或经皮支架植入术(PTS)处理责任血管18根。首次PTA或PTS后血管通畅率100%,术后6个月、12个月、24个月分别有3例、8例、13例发生再狭窄,再狭窄率分别为16.7%、44.4%、72.2%,再次予以PTA或PTS治疗。随访中2例支架移位,其中1例移位至右心房。结论介入治疗可有效解除肾透析患者CVS的相关临床症状,改善透析通路功能。Objective To evaluate the clinical effect of endovascular interventional treatment in maintenance hemodialysis(MHD)patients with central venous stenosis(CVS).Methods 18 MHD patients with CVS in our hospital were analyzed retrospectively.All patients had symptoms related to central venous returning obstacles with different degrees.Interventional treatments were carried out in all the criminal central veins,and the patients'clinical symptoms and central venous patency degrees were observed after the operations.Kesults All the central venous lumina were dilated after the interventional treatment and the related symptoms of central venous returning obstacles disappeared.PTA or PTS was used to treat 18 criminal blood vessels,and the first patency rate was 100%.After 6,12 and 24 months there were 3,8 and 13 patients occurred restenosis and the restenosis rate was 16.7%,44.4%and 72.2%,respectively.And then the restenosis patients underwent PTA or PTS treatment again.At follow-up,2 steni migration were observed,1 of which migrated to the right atrium.Conclusion Interventional treatment can effectively relieve the related clinical symptoms of maintenanee hemodialysis patients with CVS and improve the function of hemodialysis access.

关 键 词：维持性肾透析 中心静脉狭窄 经皮球囊血管成形术 经皮支架植入术 

分 类 号：R459.5[医药卫生—治疗学] R543.6[医药卫生—临床医学]