CT血管成像和超声在血液透析动静脉内瘘功能障碍诊断中的应用比较  

Comparison the use of CT angiography and ultrasound in diagnosis of fistula dysfunction in dialysis patients

作　　者：曹正江[1] 崔天蕾[2] 金丽珠[2] 周莉[2] 付平[2] 唐万欣[2] 苏白海[2] 胡章学[2] 陶冶[2] 

机构地区：[1]武警四川总队成都医院血透室,成都610041 [2]四川大学华西医院肾脏内科,成都610041

出　　处：《重庆医学》2011年第23期2324-2326,2329,共4页Chongqing medicine

摘　　要：目的对应用动静脉内瘘作为永久性血管通路的维持性血液透析患者在内瘘功能障碍时应用CT血管成像技术进行判断和影像学评价,探讨CT血管成像技术在该领域的应用价值。方法对23例自体动静脉内瘘功能障碍的尿毒症患者,应用64排螺旋CT血管成像技术进行检查,同时采用彩色多普勒超声作为对照,观察内瘘血管的狭窄部位、程度、血栓形成及侧支循环情况,并对两种主要的后处理方法进行对比。结果 23例患者均经血管成像技术明确瘘管病变的部位。流入动脉狭窄3例,其中轻度1例,中度1例,重度1例;流出静脉狭窄12例,轻、中及重度分别为4例、5例及3例,其中伴有血栓形成1例;吻合口狭窄12例;出现侧支循环3例,2例伴有上肢肿胀,CT血管成像技术和超声比较,在动脉狭窄、流出道狭窄、血栓形成方面完全吻合;对于内瘘功能障碍并发整个上肢肿胀者超声无法详细描述中心静脉情况,CT能详细描述锁骨下静脉、头臂干、上腔静脉是否有狭窄或血栓形成;超声更方便监测提供吻合口、动脉狭窄处、流出道狭窄处的血管内径。结论自体动静脉内瘘发生功能障碍时,超声应作为首选的临床检查手段,但内瘘功能障碍并发整个上肢肿胀时,64层螺旋CT血管成像技术可对手术干预提供更有价值的帮助。Objective To evaluate the feasibility and effect of CT angiography（CTA） in the assessment of dysfunction of arterio-venous fistula（AVF） in patients on maintenance haemodialysis.Methods Data of 23 chronic renal failure patients who had AVF dysfunction and underwent 64-detector CTA was prospectively collected and analyzed.CTA was taken to detect the position and degree of vascular stenosis,thrombosis,and collateral circulation around AVF,and two methods of CTA image post-processing were compared.Results CTA clearly demonstrated the lesion location of AVF in all cases enrolled.Three cases had afferent arterial stenosis（one with mild stenosis,one with moderate stenosis,and one with severe stenosis）.Twelve cases had efferent venous stenosis（four with mild stenosis,five with moderate,three with severe） among which there were one case with thrombosis.Twelve cases had anastomotic stricture.Three cases had collateral circulation formation around AVF,two of which with upper arm swelling.CTA had provided information coincident with that of ultrasound examination about afferent arterial stenosis,anastomotic stricture,and thrombosis.Besides,it could give detailed information of stricture and thrombosis of brachiocephalic vein,superior vana cava,and subclavian vein.However,ultrasound was more preferred to evaluate the inner diameter of vessels at anastomosis site and vascular strictures.Conclusion Ultrasound examination is the first choice for patients doubted with AVF dysfunction.However,64-detector CTA may be an alternative imaging test in some circumstances,especially when patients suffered from upper limb swelling,to provide more information helpful for surgical intervention.

关 键 词：动静脉瘘 体层摄影术 螺旋计算机 超声检查 多普勒 彩色 

分 类 号：R692.5[医药卫生—泌尿科学]