血液透析患者肿胀手综合征的诊治

Diagnosis and management of upper extremity edema syndrome in hemodialysis patients

目的总结血液透析患者患肢肿胀的诊断、治疗经验。方法回顾性分析上海交通大学医学院附属仁济医院2006年7月至2011年6月收治的51例肿胀手综合征的临床资料,总结其发病部位、治疗方法及效果。结果男31例,女20例,平均年龄(60.18±14.38)岁。平均血管通路建立时间(36.35±28.94)月,左上肢28例,右上肢23例,病程1天～2年。术前经静脉造影、血管超声及CTV明确诊断,50例病例为动静脉内瘘回流静脉狭窄或闭塞病变,1例为返流性病变导致静脉高压。分别采用手术重建、球囊扩张术、支架植入术、血管通路关闭术等方法,症状均缓解。结论肿胀手综合征是由于静脉回流障碍或返流造成肢体远端静脉高压,影响血管通路的使用。血管超声和静脉造影联合应用能明确诊断病变部位及范围,最常见的病变部位多为中心静脉病变。上肢浅静脉病变,手术重建是最好的治疗方法。头静脉汇入锁骨下静脉处病变、中心静脉病变位置较深,手术重建创伤大,以腔内治疗为主,但远期通畅率低,需要加强随访监测。

Objectives To summarize the diagnosis and management experiences for upper extremity edema in hemodialysis patients.Methods We retrospectively analyzed 51 cases with upper extremity edema in hemodialysis patients from July 2006 to June 2011 in our department.Their location of the lesion,method of management,and outcomes were summarized.Results There were 31 males and 20 females with the mean age of(60.18±14.38) years(21-88yrs).Their vascular accesses for hemodialysis(28 cases in left and 23 cases in right) lasted(36.35±18.94) months.The symptom occurred for one month to two years.Duplex and venography were used preoperatively,and 50 stenosis or occlusion lesions and one reflux lesion were identified.The symptoms were resolved by surgical revision,angioplasty,stent or closure of the access.Conclusions The upper extremity edema resulted mainly from venous hypertension in hemodialysis patients.Combined use of duplex and venography were helpful for the diagnosis of location and extent of the lesions.Central venous stenosis or occlusion was the common lesion.Surgical revision is recommended for the superficial venous lesions.For cephalic arch and central vein lesions,angioplasty or stent placement may be the best choice to decrease the surgical trauma,but the long-term patency rate is low.Therefore,careful surveillance must be carried out.