经皮腔内支架植入术治疗中心静脉狭窄29例分析

doi:10.3877/cma.j.issn.2095-5782.2020.02.002

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 108 -113. doi: 10.3877/cma.j.issn.2095-5782.2020.02.002

所属专题：经典病例；经典病例；文献；

血管介入

经皮腔内支架植入术治疗中心静脉狭窄29例分析

郭辉¹, 刘佳妮², 张永裕¹, 张慧涛¹, 贺嘉男¹, 甘海润¹, 赵逆¹, 庞鹏飞¹^,^†(

)

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

收稿日期:2020-04-04 出版日期:2020-05-25
通信作者: 庞鹏飞

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

Hui Guo¹, Jiani Liu², Yongyu Zhang¹, Huitao Zhang¹, Jia'nan He¹, Hairun Gan¹, Ni Zhao¹, Pengfei Pang¹^,^†()

^1. Department of Interventional Vascular Surgery, Interventional Medical Centre
^2. Department of Head and Neck Oncology, Cancer Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000, China

Received:2020-04-04 Published:2020-05-25
Corresponding author: Pengfei Pang
About author:
Corresponding author: Pang Pengfei; Email: pflb@sina.com

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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%）（χ²=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%）（χ²=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%，χ²= 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。

关键词: 中心静脉狭窄, 经皮腔内支架植入术, 再狭窄, 抗凝

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 re-intervention was performed. The restenosis rate of bare stent after PTS (45.8%) was significantly higher than that of covered stent (10.0%) (χ²=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 (χ2=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%, χ2=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.

Key words: Central venous stenosis, Percutaneous transluminal stenting, Restenosis, Anticoagulan

图1 患者男性，53岁，因"上腔静脉支架植入术后7月余，右上肢肿胀1周"入院；患者既往因慢性肾功能衰竭建立右上肢自体动静脉瘘，行血液透析治疗

图2 首次采用裸支架与覆膜支架行PTS治疗CVS术后一期通畅率的比较

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