裸支架与覆膜支架植入治疗血液透析患者中心静脉完全闭塞的临床疗效比较

目的观察和比较裸支架与覆膜支架植入术治疗血液透析患者中心静脉完全闭塞的早中期临床疗效。方法入选2015年1月至2017年1月中山大学附属第一医院的66例中心静脉完全闭塞的血液透析患者为研究对象,所有患者均接受经皮腔内血管成形术(PTA)+支架植入治疗,支架植入成功且随访资料完整。按植入支架类型不同分为裸支架组(n=46)和覆膜支架组(n=20)。比较两组的手术成功率、术后疗效及术后第1、3、6、9、12个月的初次通畅率。结果66例患者术后第2天临床症状明显好转。裸支架组患者术后第1、3、6、9、12个月的初次通畅率分别为97.83%、95.65%、69.56%、41.3%、34.78%;覆膜支架组术后第1、3、6、9、12个月的初次通畅率分别为100%、100%、95%、65%、60%。两组术后第9、12个月初次通畅率的差异有统计学意义(均P<0.05)。裸支架组中位通畅时间为(8.52±0.49)个月,覆膜支架组中位通畅时间为(10.30±5.32)个月,两组间的差异有统计学意义(P=0.046)。结论支架植入治疗血液透析患者中心静脉完全闭塞可获得较好的临床疗效,覆膜支架植入有更好的中期通畅率及中位通畅时间。

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.