血管成形术在上腔静脉闭塞血液透析患者长期透析导管置入中的临床效果分析

Efficacy of angioplasty for tunneled cuffed catheter placement in hemodialysis patients with superior vena cava occlusion

目的评价血管成形术对上腔静脉闭塞血液透析患者在数字减影血管造影(digital subtraction angiography,DSA)引导下置入带隧道和涤纶套的透析导管(tunneled cuffed catheter,TCC)的临床效果。方法回顾性纳入2017年12月至2020年6月于中山大学附属第一医院行TCC置入的62例血液透析患者,根据上腔静脉有无闭塞分为实验组和对照组,实验组为上腔静脉闭塞血液透析患者(n=20),采用球囊扩张、支架置入、锐性再通技术的血管成形术开通上腔静脉后,在DSA指引下置入TCC;对照组为无上腔静脉闭塞的血液透析患者(n=42),仅在DSA指引下置入TCC。比较两组患者的1年TCC通畅率、术后TCC血流量和手术相关并发症。结果实验组使用单纯球囊扩张11例,球囊扩张联合支架置入9例,锐性再通技术开通上腔静脉3例;共使用支架9枚,使用球囊29个。实验组透析病程长于对照组(P<0.05)。实验组和对照组的1年TCC通畅率分别为85.0%和95.2%(P>0.05),术后TCC血流量分别为(257.83±16.55)ml/min和(251.90±18.79)ml/min(P>0.05),手术相关并发症(1~2级)发生率分别为30.0%和35.7%(P>0.05),两组患者均未发生严重的手术相关并发症,仅有部分患者出现穿刺点渗血、术后疼痛等轻症。结论对于透析病程更长且出现上腔静脉狭窄、闭塞的患者,采用血管成形术后,其1年内的临床效果与未采用血管成形术的普通透析患者相当。

Objective To evaluate the efficacy of angioplasty on percutaneous superior vena cava occlusion in hemodialysis patients with tunnel-cuffed catheter(TCC)under digital subtraction angiography(DSA)guidance.Methods A total of 62 hemodialysis patients with TCC in the First Affiliated Hospital of Sun Yat-sen University from December 2017 to June 2020 were enrolled retrospectively.According to the patency of the superior vena cava,the patients were divided into experiment group(n=20)and control group(n=42)in this study.Hemodialysis patients with superior vena cava occlusion in the experiment group received angioplasty,including balloon angioplasty,stenting and sharp recanalization,and catheterization with TCC under DSA guidance,while hemodialysis patients without superior vena cava occlusion in the control group only underwent catheterization with TCC under DSA guidance.The 1-year TCC patency rate,postoperative TCC blood flow and treatment-related complications between the two groups were compared.Results In the experiment group,a total of 11 patients were treated only by percutaneous transluminal angioplasty,while 9 patients were treated combined percutaneous transluminal angioplasty with stent placement.In addition,3 patients underwent sharp recanalization of superior vena cava occlusion.A total of 9 stents and 29 balloons were used.The course of dialysis in experiment group was longer than that in control group(P<0.05).There were no significant differences in the 1-year TCC patency rate(85.0%vs 95.2%,P>0.05),postoperative TCC blood flow[(257.83±16.55)ml/min vs(251.90±18.79)ml/min,P>0.05]and incidence of treatment-related complications(grade 1-2,30.0%vs 35.7%,P>0.05)between the two groups,respectively.Patients in the two groups had none of serious operation-related complications,and only some patients had mild clinical manifestations,such as postoperative pain and bleeding at the puncture point.Conclusions For patients with longer duration of hemodialysis and superior vena cava stenosis and occlusion treated with angioplasty,the clinical effect of TCC within one year is equivalent to that of hemodialysis patients without angioplasty.