本文選題：血液透析 + 自體動(dòng)靜脈內(nèi)瘺��； 參考：《介入放射學(xué)雜志》2017年08期

【摘要】：目的探討經(jīng)皮血管支架植入術(shù)(PTS)治療自體動(dòng)靜脈內(nèi)瘺(AVF)透析患者中心靜脈阻塞(CVO)可行性及臨床應(yīng)用價(jià)值。方法回顧性分析10例AVF伴CVO患者,臨床均表現(xiàn)為手腫脹綜合征。術(shù)前或術(shù)中均接受DSA檢查明確阻塞部位,根據(jù)不同病情采用合適手術(shù)入路,伴有血栓形成患者先行導(dǎo)管接觸溶栓(CDT),嚴(yán)重狹窄或閉塞患者先以小直徑球囊預(yù)擴(kuò)張遂行PTS,其余患者直接行PTS。結(jié)果 DSA顯示5例有頸內(nèi)靜脈置管史患者為頭臂靜脈閉塞或/和鎖骨下靜脈、頸內(nèi)靜脈、上腔靜脈閉塞或狹窄,5例無(wú)頸內(nèi)靜脈置管史患者均表現(xiàn)為內(nèi)瘺側(cè)鎖骨下靜脈內(nèi)側(cè)段局限性嚴(yán)重狹窄。10例PTS技術(shù)成功率為100%,植入支架19枚,1例(鎖骨下靜脈狹窄)術(shù)后7個(gè)月支架內(nèi)再狹窄再行PTS術(shù)。一期通暢率在術(shù)后6個(gè)月為8/8,術(shù)后1年為3/4。結(jié)論 AVF透析患者CVO多為閉塞性或嚴(yán)重狹窄病變,PTS治療成功率高、近中期效果滿意、并發(fā)癥輕微,安全有效、可行,可作為首選治療方法。
[Abstract]:Objective to investigate the feasibility and clinical value of percutaneous transluminal stent implantation (PTSs) in the treatment of central vein occlusion (CVOO) in patients with AVF. Methods Ten cases of AVF with CVO were retrospectively analyzed. Preoperative or intraoperative DSA examination was performed to determine the location of obstruction, and appropriate operative approaches were adopted according to different conditions. Patients with thrombus were treated with catheter contact thrombolytic thrombolytic thrombolysis (CDT). The patients with severe stenosis or occlusion were performed PTSs with small diameter balloon dilatation first, and the others with PTSs directly. Results DSA showed that 5 patients with history of internal jugular vein catheterization were occluded or / or subclavian vein and internal jugular vein. 5 cases of superior vena cava occlusion or stenosis without history of internal jugular vein indwelling showed severe local stenosis of medial segment of subclavian vein of internal fistula. Success rate of PTS technique was 100%, and 19 stents were implanted in 1 case (subclavian vein stenosis). PTS was performed 7 months after stent restenosis. The primary patency rate was 8 / 8 at 6 months and 3 / 4 at 1 year. Conclusion CVO in AVF dialysis patients with occlusive or severe stenosis has a high success rate, satisfactory results in the near and middle stage, mild complications, safety and effectiveness, and can be used as the first choice for the treatment.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬蘇州九龍醫(yī)院介入血管外科;
【分類(lèi)號(hào)】：R692.5

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