药物涂层球囊在血液透析通路中的临床应用

Clinical application of drug-coated balloon in hemodialysis access

目的探讨药物涂层球囊(drug-coated balloon,DCB)治疗血液透析通路狭窄的临床效果及应用体会。方法回顾性分析2017年1月—2021年12月上海中医药大学附属龙华医院血管外科应用DCB经皮腔内球囊扩张术治疗血液透析通路各部位狭窄的57例患者的治疗效果。采用Kaplan-Meier法绘制DCB扩张后的初级通畅率曲线。采用Log-rank检验比较再发狭窄患者DCB扩张后与之前高压球囊扩张后的效果,原发狭窄病变与再发狭窄病变及3种不同类型DCB扩张的治疗效果。结果患者术后平均随访时间为(17.75±13.48)个月。DCB扩张后6、12、24个月的初级通畅率分别为78.7%、40.7%和24.1%,初级通畅中位时间为11个月。其中24例曾行高压球囊扩张,DCB扩张后与之前高压球囊扩张后的初级通畅率相比较,DCB具有更好的初级通畅率(6个月初级通畅率为79.2%比25.0%,12个月初级通畅率为40.9%比12.5%,P值均<0.05);原发狭窄与再发狭窄患者DCB扩张的通畅时间和3种不同类型DCB扩张后通畅时间比较,差异均无统计学意义(P值均>0.05)。结论DCB治疗血液透析通路狭窄具有更好的通畅率,影响DCB疗效的因素有待进一步研究。

Objective To explore the clinical effect of drug-coated balloon(DCB)on hemodialysis access stenosis.Methods A retrospective analysis was performed involving 57 patients with hemodialysis access stenosis treated by DCB percutaneous balloon dilation in the Department of Vascular Surgery,Longhua Hospital,Shanghai University of Traditional Chinese Medicine from January 2017 to December 2021.Kaplan-Meier method was used to plot the primary patency curves after DCB dilatation.Log-rank test was used to compare the effects of DCB dilation with high pressure balloon dilation and primary stenotic lesions versus recurrent stenotic lesions and three types of DCB dilation.Results The mean follow-up time was(17.75±13.48)months.The primary patency rates at 6,12 and 24 months after DCB expansion were 78.7%,40.7%and 24.1%,respectively,with a median time of 11 months.Among them,24 patients had been treated with high pressure balloon expansion.There were higher primary patency rates after DCB treatment than high pressure balloon expansion(79.2%vs.25.0%at 6 months,40.9%vs.12.5%at 12 months,both P<0.05).There was no statistical difference in the patency time of DCB between patients with de nove stenosis and recurrent stenosis and between the three types of DCB(all P>0.05).Conclusion DCB expansion can achieve a high patency rate for hemodialysis access stenosis.The factors affecting the efficacy of DCB need further study.