中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (11): 598-601.doi: 10.3969/j.issn.1671-4091.2013.11.00

• 临床研究 • 上一篇    下一篇

肿胀手综合征介入治疗及复发分析

杨涛1,詹申1,王仲朴2,王玉柱3,王新玲4   

  1. 1. 北京市海淀医院
    2. 北京市海淀医院放射科
    3. 北京市海淀医院肾内科
    4. 吉林省蛟河市人民医院血液净化中心
  • 收稿日期:2013-06-04 修回日期:2013-07-11 出版日期:2013-11-12 发布日期:2013-11-12
  • 通讯作者: 王玉柱 yangtaodoctor@163.com E-mail:yangtaodoct@163.com

Endovascular therapy to the upper extremity edema syndrome and analyzing to recurrence.

  • Received:2013-06-04 Revised:2013-07-11 Online:2013-11-12 Published:2013-11-12

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摘要： 目的 探讨血液透析患者肿胀手综合征的发病特点、介入治疗方法和肿胀手复发影响因素。方法88位肿胀手患者，按肿胀手在治疗后于观察期限内是否复发分为未复发组和复发组。采用介入下造影方式明确中心静脉病变位置，球囊扩张或植入支架治疗。考察透析患者置管史与中心静脉病变的关系，观察治疗方式和治疗后复发情况。结果88位患者共行116例次介入检查治疗，15人因导丝无法通过或采用其他手术方式，3人未见中心静脉异常，其余70人中心静脉经过球囊扩张或支架植入后即刻开放；50位患者有同侧颈内静脉置管史，肿胀手症状出现距离内瘘手术时长26.4±32.5月，中心静脉病变的位置多位于锁骨下静脉和头臂静脉。经介入治疗后，观察期内23例患者35次肿胀手复发，再次复发距离上次治疗时间6.9±4.9月，复发组与未复发组一般资料上相比差异无统计学意义（P＞0.05）。虽 治疗上选择球囊扩张还是支架植入差别亦无统计学意义，但复发组支架植入的比例相对更高。结论 血液透析患者由于中心静脉置管、动静脉内瘘术后血流动力学改变等原因，导致中心静脉狭窄或闭塞，引起肿胀手综合征。球囊或支架植入治疗后，肿胀手综合征仍有较高的复发率，支架植入治疗者复发率可能更高。

关键词: 血液透析, 肿胀手综合征, 中心静脉狭窄, 介入治疗

Abstract: Objective To analyze the clinical characters of upper extremity edema syndrome in hemodialysis patients, explore the endovascular therapy way to this syndrome and investigate the recur causes . Methods Eighty eight upper extremity edema syndrome patients were recruited. And 116 percutaneous transluminal angioplasty therapies were carried out. The subjects were classified into two groups according to whether the edema symptoms were emerged once more. If central vein stenosis or obstruction were diagnosed with X ray, endovascular therapies including angioplasty or stent placement. Evaluate the relation between the central vein stenosis and the history of central venous catheter inserted and investigate the influencing factors to recurrence. Results All patients received endovascular therapy were recovered unless fifteen patients received other therapies and central vein stenosis were not found in three patients. Fifty patients had the history of ipsilateral central vein catheter inserted. From the fistulation to the symptom of upper extremity edema appeared , 26.4±32.5 months had been passed. Central vein stenosis or obstruction in subclavian vein and brachiocephalic vein were mostly been seen among all causes. In the investigating duration, 23 patients had to face the recurrence of the edema and total recur were 35 times within 7 months after endovascular therapy. And statistical difference were not found between two groups (P＞0.05). But the ratio of stent placement in recurrence group was higher though statistical difference wasn’t existed (P＞0.05). Conclusion The upper extremity edema syndrome in hemodialysis patients was caused by the insertion of the central vein catheter and the change of hemodynamics in the central vein after fistula. Recurrence often be seen in these patients even if they had been received endovascular therapy, especially in the patients who received stent placement.

Key words: Hemodialysis, Upper extremity edema syndrome, Central vein stenosis, Endovascular therapy.