经皮腔内血管成形术治疗血液透析患者肿胀手综合征

摘要

目的 探讨经皮腔内血管成形术(PTA)治疗血液透析患者肿胀手综合征(SHS)的成功率、通畅时间及其影响因素.方法 回顾性分析2015年5月至2017年3月采用PTA术治疗的16例SHS患者临床资料,观察技术成功率并随访初级通畅时间和初级通畅率,分析影响技术成功率及通畅时间的因素.结果 静脉DSA显示16例患者共16处狭窄/闭塞,其中狭窄病变6例,闭塞病变10例.PTA治疗成功14例,其中1例球囊扩张后即刻造影显示狭窄仍＞50％,予植入支架,技术成功率为87.5％;失败2例,因导丝无法通过长段闭塞血管.14例随访3 ～24个月,中位通畅时间为10.5个月,3、6、12个月初级通畅率分别为71.4％(10/14)、57.1％(8/14)、42.9％(6/14).单因素分析发现闭塞长度、血管成形时所需球囊压力,是影响术后通畅时间的因素.结论 PTA术治疗血液透析患者SHS安全有效,但远期通畅率仍需进一步提升.%Objective To evaluate the success rate,vascular patency time and their influencing factors of percutaneous transluminal angioplasty (PTA) in treating swollen hand syndrome in hemodialysis patients.Methods The clinical data of 16 hemodialysis patients with swollen hand syndrome,who were admitted to authors' hospital during the period from May 2015 to March 2017 to receive PTA,were retrospectively analyzed.The technical success rate,the follow-up primary vascular patency time and primary patency rate were calculated,and the factors influencing technical success rate and vascular patency time were analyzed.Results Venography with DSA revealed that a total of 16 segments of venous stenosis or occlusion were found in 16 patients,including 6 stenotic lesions and 10 occlusive lesions.Successful PTA was obtained in 14 patients,including one patient whose angiography performed immediately after PTA with balloon dilatation showed that the stenosis was still over 50％,and stent implantation had to be carried out.The technical success rate was 87.5％,in 2 patients PTA failed as the guide wire could not pass through the long segment of vascular occlusion.The 14 patients were followed up for 3-24 months,and the median patency time was 10.5 months.The 3-,6-and 12-month primary patency rates were 71.4％ (10/14),57.1％ (8/14) and 42.9％ (6/14) respectively.Univariate analysis indicated that the length of occlusive segment and the balloon pressure required for angioplasty were the potential factors that affected the postoperative vascular patency time.Conclusion For the treatment of swollen hand syndrome in hemodialysis patients,PTA is safe and effective,although long-term vascular patency rate needs to be further improved.