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

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

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。

Objective： To observe the efficay of pereutaneous transluminal balloon angioplasty （PTA） and percutaneous translunfinal 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 pateney rates and assisted primary pateney 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.