血液透析通路头静脉弓狭窄病变特点及其治疗的研究  

Study of characteristics and treatment of cephalic arch stenosis in hemodialysis access

作　　者：田然[1] 谭正力[1] 陈欣[1] 缪鹏[1] 姚辰亮 郁正亚[1] Tian Ran;Tan Zhengli;Chen Xin;Miao Peng;Yao Chenliang;Yu Zhengya(Department of Vascular Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院血管外科,北京100730

出　　处：《中国血管外科杂志（电子版）》2021年第4期346-349,共4页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：首都医科大学附属北京同仁医院科研种子基金项目(TRYY-KYJJ-2016-035)。

摘　　要：目的分析血液透析通路导致头静脉弓病变的特点,优化头静脉弓狭窄病变的防治措施。方法回顾性分析首都医科大学附属北京同仁医院2015年1月至2021年1月因透析通路导致症状性头静脉弓狭窄43例患者资料,采用头静脉弓分区分析病变特点,并随访术后通畅率。结果患者发病前通路主要回流途径均为上臂头静脉,头静脉弓单发及串联病变好发于Ⅳ区(58.1%)。患者共手术干预63例次,其中开放手术8例,腔内治疗55例次,技术成功率100%。PTA术中发生头静脉弓破裂3例,术后30 d无其他并发症发生。患者术后随访率90.7%,中位随访时间为16个月,开放手术和腔内治疗患者术后12个月的一期通畅率分别为100%和55.1%,差异有统计学意义(P=0.002)。结论避免上臂头静脉成为单一回流途径是减少症状性头静脉弓狭窄发生的方法。Ⅳ区是头静脉弓狭窄的高发区,开放手术的短期治疗效果优于腔内手术治疗。Objective To analyze the characteristics of cephalic arch lesions caused by hemodialysis access,and optimize the prevention and treatment measures of cephalic arch stenosis.Methods The clinical data of 43 patients with symptomatic cephalic arch stenosis due to hemodialysis access in Beijing Tongren Hospital,Capital Medical University between January 2015 and January 2021 were analyzed retrospectively.The cephalic arch segment was used to analyze the characteristics of the cephalic arch lesions and we calculated the postoperative patency rate.Results Before the onset the main outflow tract of arteriovenous fistulas was the upper arm cephalic vein.The single or series lesions of the cephalic arch more likely occurred in domain Ⅳ(58.1%).There were a total of 63 cases of surgical intervention,including 8 cases of open surgery and 55 cases of endovascular treatment.The technical success rate was 100%.There were 3 cases of cephalic venous arch rupture during PTA,and no other complications occurred in 30 days after operation.The postoperative follow-up rate of patients was 90.7%,with median follow-up time of 16 months.The primary patency rate was 100% in patients with open surgery and 55.1% in patients with endovascular treatment.The difference is statistically significant(P=0.002).Conclusion Avoiding the upper arm cephalic vein as a single outflow tract of arteriovenous fistulas can reduce the occurrence and development of symptomatic cephalic arch stenosis.Domain Ⅳ is a high incidence area of lesions,and the effect of open surgery is better than that of endovascular treatment.

关 键 词：头静脉弓 静脉狭窄 血液透析 腔内治疗 手术 

分 类 号：R654.3[医药卫生—外科学]