超声引导下经皮腔内血管成型术治疗自体动静脉内瘘狭窄  

Ultrasound-guided percutaneous transluminal angioplasty in the treatment of stenosis of autogenous arteriovenous fistulas

作　　者：黄俊[1] 刘日光[1] 陈浩雄[1] 梁鸣[1] 秦曙光[1] 傅君舟[1] Huang Jun;Liu Rignang;Chen Haoxiong;Liang Ming;Qin Shuguang;Fu Junzhou(Department of Nephrology ,Guangzhou First People's Hospital,Guangzhou 510180,China)

机构地区：[1]广东省广州市第一人民医院肾内科,510180

出　　处：《中国综合临床》2019年第1期41-44,共4页Clinical Medicine of China

基　　金：广东省科技计划项目(2016ZC0234).

摘　　要：目的评估超声引导下经皮腔内血管成型术(percutaneous transluminal angioplasty,PTA)治疗维持性血液透析患者自体动静脉内瘘狭窄的疗效和安全性。方法回顾性分析2016年9月至2017年8月在广州市第一人民医院诊断自体动静脉内瘘狭窄的30例维持性血液透析患者行首次超声引导下PTA,观察其术前、术后内瘘狭窄处血管内径和内瘘自然血流量变化,术后随访记录其内瘘使用时间及并发症。结果93.3%(28/30)患者首次超声引导下PTA手术成功,其内瘘狭窄处血管内径由术前(1.62±0.30) mm增至术后(3.61±0.66) mm(t=18.205,P<0.001),内瘘自然血流量由术前(270.0±36.5) ml/min增至术后(611.4±46.6) ml/min(t=50.221,P<0.001)。首次超声引导下PTA成功患者术后90 d和180 d通畅率分别为96.4%(27/28)和85.7%(24/28) 。术中未出现血管破裂等严重并发症,术后有1例周围肿胀,1例渗出。结论超声引导下PTA是治疗维持性血液透析患者自体动静脉内瘘狭窄一种安全有效的方式。Objective To assess the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty (PTA) for treatment of stenosis of autogenous arteriovenous fistulas in maintenance hemdialysis patients.Methods From September 2016 to August 2017, thirty patients with autologous arteriovenous fistula (AVF) stenosis diagnosed in Guangzhou First People′s Hospital underwent PTA under the guidance of ultrasound for the first time.The vascular diameter of AVF stenosis and the blood flow of AVF before and after operation were evaluated.During the follow-up period, the patency time and complications were recorded.Results In 93.3% (28/30) patients, primary ultrasound-guided PTA procedures were successfully performed.The internal diameter of the stenosis increased from (1.62±0.30) mm preoperatively to (3.61±0.66) mm postoperatively (t=18.205, P<0.001), and the natural blood flow increased from (270.0±36.5) ml/min preoperatively to (611.4±46.6) ml/min postoperatively (t=50.221, P<0.001). The post-intervention primary patency rates at 90 and 180 d were 96.4% (27/28) and 85.7% (24/28), respectively.There was no rupture of the vein, or other severe complication during the PTA procedure.One patient had perilesional swelling, and one patient had extravasation after the PTA procedure.Conclusion Ultrasound-guided PTA is a safe and effective method for treatment of stenosis of autogenous arteriovenous fistulas in maintenance hemdialysis patients.

关 键 词：动静脉内瘘 狭窄 经皮腔内血管成型术 超声 

分 类 号：R692.5[医药卫生—泌尿科学]