Central Vein Stenosis in Maintenance Hemodialysis Patients in a Medical Center of Taiwan

長期血液透析病患的中央靜脈阻塞：台灣一所醫學中心的經驗

何立鈞(Li-Chun Ho) ； 姜至剛(Chih-Kang Chiang) ； 吳寬墩(Kwan-Dun Wu)

《Acta Nephrologica》 22卷3期 (2008/09) Pp. 180-184

摘要

背景：長期血液透析的病患發生中央靜脈阻塞往往被忽略，我們因此回朔性地收集了過去九年曾因中央靜脈阻塞至台大醫院住院的血液透析病患，希望藉著分析這些資料做為日後治療的參考。
方法：我們篩選自1998年l月1日至2006年12月31日九年間曾至台大醫院住院的病歷，凡同時具有中央靜脈阻塞診斷（ICD-9 code 459.2或453.2）以及長期血液透析診斷（ICD-9 code 585或403.9或39.95）的病歷就挑選出來，個別分析這些人的臨床特徵及治療結果。
結果：在排除了因肝硬化或惡性腫瘤引起的中央靜脈阻塞後，共有17位長期血液透析的病患符合篩選條件，進入分析，這些人平均透析的時間是48.6個月。但有3人血液透析不到一年。共紀錄到24處阻塞，其中有4處是上腔大靜脈、6處是左頭臂靜脈、5處是左鎖骨下靜脈、5處是右鎖骨下靜脈、l處是左內頸靜脈、1處是右內頸靜脈、還有2處是上臂靜脈。這些阻塞半數是完全阻塞，另有半數是中等至嚴重程度阻塞。其中有11位病患過去曾於內頸動脈或鎖骨下靜脈放置中央靜脈導管。從第一次放置導管到診斷中央靜脈阻塞的時間範圍從16到138個月不等。其中有10位接受經皮血管氣球擴張術治療，只有一位放置支架。在這10人當中，只有7位成功，成功者有2位在半年內死亡，一位不再回台大醫院追蹤，剩下4位於氣球擴張術後7至32個月再度發生中央靜脈阻塞。
結論：在分析了台大醫院的經驗以後，我們發現血液透析病患發生中央靜脈阻塞，2/3與放置中央靜脈導管有關。而中央靜脈阻塞的預後不佳，因為即使實施血管氣球擴張術，發生再次阻塞的機率仍然很高。

關鍵字

血液透析 ； 中央靜脈阻塞 ； 經皮血管氣球擴張術

並列摘要

Background: Central vein stenosis (CVS) in maintenance hemodialysis (MMD) patients is usually underestimated, We examine all the MHD patients who had been admitted to National Taiwan University Hospital (NTUH) with CVS in the past 9 years. The characteristics and clinical outcome of these patients were recorded and analyzed.
Methods: We searched all the patients who had been hospitalized in NTUB from January 1st, 1998 to December 3lth, 2006 and had a discharge diagnosis of CVS (ICD-9 code 459.2 or 453.2) and MMD (ICD-9 code 585, 403.9, 39.95). Their clinical data were reviewed.
Results: After excluding CVS secondary to malignancy or liver cirrhosis, 17 MMD patients were enrolled for analysis. The mean duration of hemodialysis was 48.6 months but there were 3 patients who were on MHD for less than one year Totally, 24 stenosis sites were identified: 4 at the superior vena cava, 6 at left brachiocephalic vein, 5 at left subclavian vein, 5 at right subciavian vein, 1 at left internal jugular vein, 1 at right internal jugular vein, and 2 cit cephalic vein. Half of them were totally occluded, and the other half had moderate to severe stenosis. Eleven patients had previous cuffed or uncuffed central venous catheter placement in the jugular or subclavian vein. The duration from first cuffed and tunneled catheter insertion to the diagnosis of CVS ranged from 16.6 to 138.2 months. Ten patients received percutaneous transluminal angioplasty (PTA) but only one patient had stent placement. Three patients failed initially. Of the 7 patients with successful PTA, two patients died in half year, one patient was lost on follow up, and the other 4 patients had restenosis in 6.9 to 31.8 months.
Conclusion: In the case series of NTUH, two thirds of the CVS were related to central venous catheterization. The long term clinical outcome of PTA was complicated with high risk of restenosis.

並列關鍵字

hemodialysis ； central vein stenosis ； percutaneous transluminal angioplasty