牵张导丝技术应用于透析患者中心静脉闭塞性疾病的可行性及价值

The feasibility and application value of the through and through technique in hemodialysis patients with central venous occlusive disease

目的评估牵张导丝技术在治疗血液透析患者中心静脉闭塞手术中的可行性及应用价值。方法回顾性分析2020年1月─2023年6月张家界市人民医院血管介入外科就诊的17例中心静脉闭塞的血液透析患者的临床资料。手术中采用锐性开通技术、“穿针引线”技术建立牵张导丝通路后行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)或PTA联合支架植入治疗。统计患者的手术成功率、并发症发生率以及手术后初级通畅率。结果17例患者中,1例患者因导丝开通闭塞血管时穿出血管而手术失败,其余16例均手术成功,手术成功率94.12%。所有患者手术中无出血、纵膈血肿、心脏压塞及中心静脉破裂等相关并发症,无手术相关死亡。手术成功的16例患者手术后均正常行血液透析,上肢、面部肿胀均明显消退。随访时间6~25月,中位随访时间13.5(8.0,15.0)月。手术后6月及1年的初级通畅率分别为93.75%、75.00%。随访期间均无支架移位。结论牵张导丝技术在治疗血液透析患者中心静脉闭塞方面取得了显著的疗效,手术成功率高,并发症发生率较低,值得临床推广。

Objective To evaluate the feasibility and application value of the through and through technique in the treatment of central venous occlusion in hemodialysis patients.Methods A retrospective analysis was conducted on 17 hemodialysis patients with central venous occlusion and undergoing vascular intervention surgery at the hospital from January 2020 to June 2023.Sharp recanalization technique or"needle-wire"technique was used to establish a traction wire pathway,followed by balloon dilation or balloon dilation combined with stent implantation.Surgical success rate,incidence of complications,and postoperative patency rate were recorded.Results Among the 17 patients,one patient experienced vessel perforation during wire recanalization,resulting in surgical failure,while the remaining 16 cases achieved surgical success with a success rate of 94.12%.There were no bleeding,mediastinal hematoma,cardiac tamponade,or central venous rupture during the manipulations,and no surgical-related deaths occurred.All 16 patients who had successful surgery were able to undergo normal hemodialysis,and the swelling in the upper limbs and face significantly subsided.The follow-up period ranged from 6 to 25 months,with a median follow-up time of 13.5(8.0,15.0)months.The primary patency rates after the operation for 6 months and one year were 93.75%and 75.00%,respectively.No stent displacement occurred during the follow-up period.Conclusion The through and through technique has shown significant efficacy with a high success rate and a low incidence of complications in the treatment of central venous occlusion in hemodialysis patients,suggesting its clinical applicability.