血液透析患者中心静脉狭窄的临床特点、血管腔内治疗的效果观察

目的 探讨血液透析患者中心静脉狭窄(central vein stenosis,CVS)的临床特点以及对其实施血管腔内治疗的临床疗效.方法 选取2012年1月至2014年1月于本院行血液透析治疗且合并有中心静脉狭窄的36例患者为研究对象,采用静脉造影技术,分析其临床特点,并对其实施血管腔内治疗,观察其治疗效果.结果 本组患者包括27例中心静脉狭窄与9例中心静脉闭塞.其中,狭窄位于右侧锁骨下静脉与头臂静脉交汇处13例(36.11%),左侧头臂静脉近心端8例(22.22%),右侧头臂静脉近心端4例(11.11%),右侧腋静脉伴锁骨下静脉2例(5.56%);闭塞位于左侧头臂静脉4例(11.11%),右侧锁骨下近端5例(13.89%).36例患者中有24例行经皮血管支架植入术(pecutaneous transtuminl stenting,PTS)或经皮血管球囊扩张成形术(pecutaneous transtuminl angioplasty,PTA)联合治疗,其余12例行PTA治疗,治疗1周后患者上肢、腋部与胸壁浅表静脉曲张缓解或消失;随访期间有6例患者复发,且均为行PTA治疗的患者.结论 掌握中心静脉狭窄的临床特点,有助于患者的早期诊治,对预后具有重要意义;血液透析合并中心静脉狭窄患者行单纯PTA或PTS与PTA联合治疗,均可取得较好的治疗效果,但PTA治疗后复发的可能性较高.

Clinical characteristics of center vein stenosis in patients with hemodialysis and the effect of endovascular treatment

Objectives To explore clinical characteristics of center vein stenosis (CVS) of patients with hematodialysis and clinical efficacy of intracavitary vessel treatment.Methods A total of 36 patients who underwent hemodialysis combined with CVS in our hospital from January 2013 to January 2015 were selected as research subjects.All patients were used venography technology, and clinical characteristics were analyzed.The intracavitary vessel treatment was implemented, and its efficacy was observed.Results Patients included 27 patients with central venous stenosis and 9 patients with central venous occlusion.Thirteen cases (36.11%) were located at the junction of the right clavicle vein and the head arm vein, 8 cases (22.22%) of the proximal end of the left arm vein, 4 cases (11.11%) on the proximal end of the right arm vein, 2 cases (5.56%) of right axillary vein with the inferior vena cava.Four cases (11.11%) located in the left brachiocephalic vein occlusion, 5 cases (13.89%) on the right side of the proximal clavicle.Twenty-four cases were treated with PTS and PTA in 36 patients, 12 cases were treated with PTA.The upper limb, axillary region and the superficial varicose veins of the chest wall were relieved or disappeared after one week.Six patients relapsed during the follow-up period and who were treated with PTA.Conclusions Grasp of clinical features of central venous stenosis is helpful to the early diagnosis and treatment of the patients, be helpful to the early diagnosis and treatment of the patient.Combined treatment with PTA or PTS and PTA in patients with central venous stenosis in hemodialysis patients with central venous stenosis can achieve good therapeutic effect, but the possibility of recurrence after PTA treatment is higher.