老年尿毒症患者上腔静脉综合征介入治疗

Interventional treatment of superior vena cava syndrome in elderly patients with uremia

目的探讨介入治疗老年尿毒症患者上腔静脉综合征(SVCS)的临床效果。方法回顾性分析2018年4月至2019年4月在四川大学华西医院接受介入治疗并确诊为SVCS的52例老年尿毒症患者临床资料。观察一次手术成功率、术中并发症发生率。结果静脉DSA造影显示52例患者均有不同程度上腔静脉病变,其中狭窄病变33例,闭塞病变19例。介入治疗后一次手术成功率为100%(52/52)。52例中单纯球囊扩张44例(84.6%),支架植入8例(15.4%),术后即刻造影均显示静脉壁光滑,血液回流通畅。术中并发症发生率为3.8%(2/52),2例均为锐性开通过程中损伤上腔静脉壁而致心脏压塞,但由于破口小,经约30 min补液后自行闭合。术后随访3~12个月(平均8.9个月),根据疗效评价标准,治愈48例,有效2例,治疗有效率为96.2%(50/52);复发2例(二次介入手术后血流恢复),复发率为3.8%(2/52)。结论介入治疗老年尿毒症患者SVCS安全有效,能迅速恢复上腔静脉血流,保证透析血流量,改善患者生活质量,但远期通畅率和复发预防仍有待进一步提高和加强。

Objective To investigate the clinical efficacy of interventional therapy for superior vena cava syndrome(SVCS) in elderly patients with uremia. Methods The clinical data of 52 elderly uremia patients with proved SVCS, who were admitted to the West China Hospital of Sichuan University of China during the period from April 2018 to April 2019 to receive interventional treatment, were retrospectively analyzed. The success rate with single interventional procedure and the incidence of intraoperative complications were analyzed. Results Venography with DSA revealed that different degrees of superior vena cava(SVC) lesions were observed in all 52 patients, including stenosis(n=33) and occlusion(n=19). The success rate with single interventional procedure was 100%(52/52). Of the 52 patients, simple balloon dilatation was employed in 44(84.6%), and stent implantation was adopted in 8(15.4%). Immediate postoperative venography showed that the SVC wall was smooth and the blood flow within SVC was unobstructed. The incidence of intraoperative complications was seen in 2 patients(3.8%), and both patients developed pericardial tamponade caused by the damage of SVC wall which occurred during the process of opening SVC lumen with sharp instruments. As the rupture of SVC was rather small, it was closed by itself after intravenous infusion for about 30 minutes. The patients were followed up for 3-12 months(mean 8.9 months). According to the evaluation criteria, cure was achieved in 48 patients and effective response was seen in 2 patients, the total effective rate was 96.2%(50/52).Two patients had a relapse, and after the secondary intervention the blood flow returned to normal. The recurrence rate was 3.8%(2/52). Conclusion For SVCS in elderly patients with uremia, interventional treatment is safe and effective. It can rapidly restore the blood flow in SVC, ensure sufficient blood flow for hemodialysis and improve the quality of life of patients. However, the long-term patency rate of SVC needs to be further improved and more attention should be paid to the prevention of recurrence.