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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (02) : 137 -141. doi: 10.3877/cma.j.issn.2095-5782.2018.02.010

所属专题： 文献；

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
王宾1, 肖恩华2,†(), 尚全良2, 马聪2, 陈柱2, 罗建光2, 朱晖2, 张子曙2   
  1. 1. 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
    2. 410011　长沙，中南大学湘雅二医院放射科
  • 收稿日期:2017-11-26 出版日期:2018-05-01
  • 通信作者: 肖恩华

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

Bin Wang1, Enhua Xiao2,†(), Quanliang Shang2, Cong Ma2, Zhu Chen2, Jianguang Luo2, Hui Zhu2, Zishu Zhang2   

  1. 1. Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, China; Department of Radiology, The Second Affiliated Hospital of Hainan Medical College, Haikou 570102, China
    2. Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
  • Received:2017-11-26 Published:2018-05-01
  • Corresponding author: Enhua Xiao
  • About author:
    Corresponding author: Xiao Enhua, Email:
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王宾, 肖恩华, 尚全良, 马聪, 陈柱, 罗建光, 朱晖, 张子曙. 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]. 中华介入放射学电子杂志, 2018, 06(02): 137-141.

Bin Wang, Enhua Xiao, Quanliang Shang, Cong Ma, Zhu Chen, Jianguang Luo, Hui Zhu, Zishu Zhang. Clinical effects comparison of percutaneous transluminal balloon angioplasty and percutaneous transluminal stenting in treatment of central venous stenosis of dialysis pathway[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(02): 137-141.

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。

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
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
图1 典型病例1（男，73岁，高血压肾病、右侧肿胀手综合征）PTA治疗前后
图2 典型病例2（男，39岁，慢性肾炎、左上肢高位瘘）PTA+PTS治疗前后
表1 2组开放时间和每条静脉腔内干预次数比较
组别 例数 初级开放时间（月） 辅助初级开放时间（月） 每条静脉腔内干预次数（次）
PTA治疗组 26 5.17±1.54 5.73±0.95 1.35±0.56
PTA+PTS治疗组 14 3.57±1.71 5.68±0.82 1.93±0.47
t值 ? 3.01 0.17 -3.46
P值 ? <0.05 >0.05 <0.05
表2 2组初级开放率及初级开放时间比较
组别 例数 初级开放率(%) 辅助初级开放率(%)
1个月 3个月 6个月 1个月 3个月 6个月
PTA治疗组 26 96.2 80.7 69.2 100 92.3 92.3
PTA+PTS治疗组 14 92.9 64.3 14.3 100 100 85.7
Log Rank χ2值 ? 0.40 0.54
P值 ? >0.05 >0.05
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