经皮腔内支架植入术治疗中心静脉狭窄29例分析  

Percutaneous transluminal stenting in treatment of central venous stenosis:analysis of 29 patients

作　　者：郭辉[1] 刘佳妮 张永裕[1] 张慧涛[1] 贺嘉男 甘海润 赵逆 庞鹏飞 Guo Hui;Liu Jiani;Zhang Yongyu;Zhang Huitao;He Jia'nan;Gan Hairun;Zhao Ni;Pang Pengfei(Department of Interventional Vascular Surgery,Interventional Medical Centre,the Fifth Affiliated Hospital of Sun Yat-sen University,Guangdong Zhuhai 519000,China;Department of Head and Neck Oncology,Cancer Center,the Fifth Affiliated Hospital of Sun Yat-sen University,Guangdong Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院介入医学中心介入血管外科,广东珠海519000 [2]中山大学附属第五医院肿瘤中心头颈肿瘤科,广东珠海519000

出　　处：《中华介入放射学电子杂志》2020年第2期108-113,共6页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的评价经皮腔内支架植入术(PTS)治疗中心静脉狭窄(CVS)的临床疗效。方法回顾分析29例中心静脉狭窄患者的临床资料,所有患者均经影像学证实并接受PTS治疗。出院后于术后1个月、3个月、6个月定期接受随访,分析其影像学检查、治疗效果、并发症及再次干预等。结果 29例患者实施PTS治疗共计36例/次,技术成功率约97.2%,临床有效率约94.4%;植入支架共计48枚,其中裸支架36枚,覆膜支架12枚;所有患者均未见明显手术相关并发症。术后随访3~38个月,10例/次患者于术后出现再狭窄并行再次手术干预;其中,裸支架PTS术后再狭窄率(45.8%)显著高于覆膜支架(10.0%)(χ^2=3.852,P=0.046)。合并慢性肾功能衰竭(CRF)经自体动静脉瘘行血液透析患者PTS术后再狭窄率(57.1%)显著高于非CRF患者(19.0%)(χ^2=5.256,P=0.022)。相比于术后接受规律抗凝治疗的患者,未接受规律抗凝患者术后支架再狭窄率较高(26.67%vs 100%,χ^2=8.311,P=0.004)。结论 CVS患者接受PTS治疗可取得较好的临床效果,采用覆膜支架术后再狭窄率较低;但合并CRF接受血液透析患者PTS术后再狭窄率较高;PTS术后接受规律抗凝亦很重要。Objective TTo evaluate the effect of percutaneous transluminal stenting(PTS)in treatment of central venous stenosis(CVS).Methods Clinical data of 29 patients who were diagnosed as CVS,manifested by imaging examination,and treated by PTS were collected and reviewed retrospectively.Follow-up was performed at the first,third and sixth month after discharge.The imaging examination,clinical results,complications,and second treatment were reviewed.Results 36 treatment of PTS were performed in the patients.The technical success rate was 97.2%,and clinical effective rate was 94.4%.A total of 48 stents were implanted,including 36 bare stents and 12 covered stents.There was no complication observed among these cases.After 3-38 months of follow-up,restenosis of the stent occurred in 10 patients after PTS,and reintervention was performed.The restenosis rate of bare stent after PTS(45.8%)was significantly higher than that of covered stent(10.0%)(χ^2=3.852,P=0.046).Moreover,the restenosis rate after PTS was 57.1%in patients with chronic renal failure(CRF)undergoing hemodialysis through autologous arteriovenous fistula,and 19.0%in non-CRF patients,with significant difference(χ^2=5.256,P=0.022).Compared with patients with post-operative regular anticoagulant therapy,the restenosis rate of stent in patients without regular anticoagulant therapy was higher(26.67%vs 100%,χ^2=8.311,P=0.004).Conclusions PTS was effective in treatment of patients who suffered with CVS.The restenosis rate when performed with covered stent was lower than that with bare stent;however,the restenosis rate following PTS was higher in patients with CRF receiving hemodialysis treatment. Moreover, post-operative regular anticoagulant therapy was critical.

关 键 词：中心静脉狭窄 经皮腔内支架植入术 再狭窄 抗凝 

分 类 号：R654.3[医药卫生—外科学]