聚四氟乙烯人工血管节段植入挽救流出道狭窄动静脉内瘘的效果分析  

Polytetrafluoroethylene segment implantation for arteriovenous internal fistula with outflow tract obstruction

作　　者：张愚[1] 朱志强[1] 郑鑫[1] 马雪涛[2] 刘建威[1] 韩志友[2] 

机构地区：[1]首都医科大学附属北京佑安医院泌尿外科,北京市100069 [2]北京中医药大学东直门医院泌尿外科,北京市100700

出　　处：《中国组织工程研究》2014年第30期4911-4916,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:动静脉内瘘是长期血液透析血管通路的首选,但长期血液透析常发生静脉流出道狭窄,导致血液透析通路闭塞,采用溶栓、介入及手术修复或重新造瘘等解决动静脉内瘘狭窄都有一定的缺点。目的:对比聚四氟乙稀人工血管节段性植入与单纯性手术修复挽救发生流出道狭窄动静脉内瘘的中期效果。方法:选择血管通路静脉段狭窄患者80例,年龄22-80岁,其中试验组50例采用节段性聚四氟乙稀人工血管植入治疗,对照组30例采用单纯手术修复治疗。对比两组术后感染发生率、术后到再次发生内瘘失功时间及累积生存率。结果与结论:试验组随访10-28个月,其中9例患者在随访期间出现血管通路失功,随访6,12,18个月的累积生存率分别为100%,92%,82%;对照组随访8-28个月,其中7例患者在随访期间出现血管通路失功,随访6,12,18个月的累积生存率分别为93%,87%,77%。两组术后感染发生率比较差异无显著性意义。Kaplan-Meier生存曲线显示试验组患者累积生存率较对照组略高,但log-rank检验两组差异无显著性意义(P=0.44)。表明节段性聚四氟乙稀人工血管植入治疗在不破坏原有通路解剖结构、维持原吻合口位置、最大限度保留可穿刺血管资源的基础上,获得了与单纯手术修复相当的临床疗效。BACKGROUND： Arteriovenous internal fistula is the first choice for hemodialysis. In the process of hemodialysis, many patients suffer from venous outflow stenosis. The methods including thrombolysis, intervention, surgical repair and fistula reconstruction all have their disadvantages. OBJECTIVE： To compare the midterm effects of pOlytetrafiuoroethylene segment implantation and exclusively surgical repair in arteriovenous internal fistula with outflow tract obstruction. METHODS： Eighty patients with venous outflow stenosis, aged 22-80 years, were divided into test group （n=50; polytetrafluoroethylene segment implantation） and control group （n=30; simple surgical repair）. The post-operative infection rate, postoperative time till recurrence of fistula dysfunction, and accumulate survival rate were compared between the two groups. RESULT8 AND CONCLUSION： During the follow-up period of 10-28 months in the test group, there were nine patients with vascular access dysfunction, and the accumulate survival rate was 100% for 6 postoperative months 92% for 12 months, and 82% for 18 months. In the control group, there were seven cases of vascular access dysfunction at 8-28 months of follow-up, and the accumulate survival rate was 93% for 6 postoperative months, 87% for 12 months, and 77% for 18 months. No statistically significant difference in the postoperative infectionrate was observed between the two groups. The Kaplan-Meier survival curves showed that the accumulate survival rate was slightly higher in the test group than the control group, but there was no significant difference based on log-rank test （P=0.44）. These findings indicate that polytetrafluoroethylene segment implantation for arteriovenous internal fistula with outflow tract obstruction has the similar effects as the surgical repair if it does not alter the autologous behavior of the initial access and maximally reserve the vessels for puncture.

关 键 词：生物材料 材料相容性 聚四氟乙稀 尿毒症 血管通路 人工血管 血液透析 

分 类 号：R318[医药卫生—生物医学工程]