覆膜支架治疗血液透析合并中心静脉闭塞的临床应用

Clinical application of covered metal stents in treating central venous occlusion of different branches in hemodialysis patients

摘要目的探讨覆膜支架治疗血液透析患者不同分支中心静脉完全闭塞的临床疗效。方法选取2015年10月至2018年6月期间就诊于中山大学附属第一医院的25例血液透析合并中心静脉完全闭塞患者为研究对象,所有患者均接受经皮腔内血管成形术(PTA)+覆膜支架植入术(PTS)治疗。根据术中血管造影测量病变血管周围正常血管直径,植入不同直径大小的覆膜支架。手术成功且随访资料完整。按照支架植入血管部位的不同将患者分为锁骨下静脉组、头臂静脉组和上腔静脉组3组。分析并比较3组患者支架直径大小、初始通畅时间以及辅助初始通畅时间。结果锁骨下静脉组、头臂静脉组和上腔静脉组植入支架直径分别为(10.29±0.42)mm、(12.29±0.32)mm和13.00 mm。锁骨下静脉组与上腔静脉组、头臂静脉组支架直径的差异有统计学意义(均P<0.05)。截至随访终点,锁骨下静脉组、头臂静脉组和上腔静脉组支架初始通畅时间分别为(10.57±2.00)个月、(19.40±3.28)个月和(32.75±3.28)个月,上腔静脉组支架初始通畅时间较其他两组明显延长,差异有统计学意义(均P<0.05)。锁骨下静脉组与头臂静脉组间支架初始通畅时间的差异无统计学意义(P=0.072)。锁骨下静脉组、头臂静脉组和上腔静脉组支架辅助初始通畅时间为(15.57±3.20)个月、(25.14±2.39)个月和(39.00±3.03)个月,3组间辅助初始通畅时间的差异有统计学意义(P<0.05)。结论不同部位血管植入不同直径的覆膜支架术后血管通畅时间存在差异,管腔支架直径越大,支架通畅时间越长。注意保护管径较小的血管至关重要。

Objective To evaluate the efficacy of covered stent(CS)in the treatment of central venous occlusive disease(CVOD)of different branches in hemodialysis patients.Methods Twenty-five cases of CVOD in the First Affiliated Hospital of Sun Yat-sen University from Oct 2015 to June 2018 were enrolled.All patients underwent percutaneous transluminal angioplasty(PTA)+stent graft(PTS)successfully.The stent grafts of different diameters were implanted according to intraoperative angiography to measure the diameter of normal blood vessels around the diseased vessels.The operation was successful and the follow-up data was complete.According to the different branches of central venous lesions,the patients were divided into three groups:subclavian vein group,brachiocephalic vein group and superior vena cava group.The stent diameter,primary patency and assisted primary patency time were analyzed and compared in the three groups.Results The diameters of the subclavian vein group,the brachiocephalic vein group,and the superior vena cava group were(10.29±0.42)mm,(12.29±0.32)mm and 13.00 mm,respectively.There were significant differences in the diameters of the subclavian vein group,the superior vena cava group and the brachiocephalic vein group(both P<0.05).As of the end of follow-up,the primary patency time of the subclavian vein group,the brachiocephalic vein group,and the superior vena cava group was(10.57±2.00)months,(19.40±3.28)months,and(32.75±3.28)months respectively.The primary patency time of the superior vena cava group was significantly longer than the other two groups(P<0.05).There was no significant difference in the primary patency time between the subclavian vein group and the brachiocephalic vein group(P=0.072).The assisted primary patency time of the subclavian vein group,the brachiocephalic vein group and the superior vena cava group was(15.57±3.20)months,(25.14±2.39)months,(39.00±3.03)months.There was a statistically significant difference in the assisted primary patency time between the three groups(P<0.05).Conclusions There are differences in vascular patency between postoperative vascular grafts of different diameters in different sites.The larger the diameter of the lumen stent,the longer the stent patency time is.It is important to protect the blood vessels with smaller diameters.