球囊扩张与血管再吻合治疗糖尿病血液透析患者自体动静脉内瘘近吻合口狭窄的对比研究  

Comparative study of percutaneous transluminal angioplasty and neo-anastomosis to treat juxta-anastomotic stenosis of autologous arteriovenous fistula in patients with diabetes mellitus

作　　者：李敏侠[1] 吕佳璇[1] 赵俊来[2] 李月红[1] 庄震[1] 武向兰 Li Minxia;Lyu Jiaxuan;Zhao Junlai;Li Yuehong;Zhuang Zhen;Wu Xianglan(Department of Nephrology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院肾脏内科,102218 [2]清华大学附属北京清华长庚医院血管外科,102218

出　　处：《中国医师进修杂志》2019年第12期1081-1084,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的对比观察经皮球囊扩张(PTA)和血管再吻合两种方法在糖尿病血液透析患者自体动静脉内瘘(AVF)近吻合口狭窄中的疗效,探讨适宜的临床治疗方式。方法回顾性分析2016年2月至2018年12月在清华大学附属北京清华长庚医院行AVF手术,进行维持性血液透析,发生近吻合口狭窄的糖尿病患者,分别行PTA和血管再吻合手术,对比两组患者的临床资料、手术成功率和术后通畅时间等指标。结果PTA组患者13例,其中1例手术失败,1例术后有血栓形成,成功率为11/13;血管再吻合组15例,其中13例成功,成功率为13/15,两组成功率比较差异无统计学意义(P>0.05)。术后两组中位随访时间分别为11(7~12)个月和15(5~22)个月,差异无统计学意义(P>0.05)。PTA组术中出血量、血管损失长度、操作时间均少于血管再吻合组[3(2~4)ml比20(10~40)ml、0比(3.6±1.2)cm、(0.6±0.7)h比(1.8±0.5)h],差异有统计学意义(P<0.05)。结论PTA与血管再吻合治疗糖尿病血液透析患者的近吻合口狭窄均具有较好的通畅性,PTA具有血管损伤少,手术时间短,出血量少,可同时扩张动脉等优势。Objective To compare the efficacy of percutaneous transluminal angioplasty(PTA)and neo-anastomosis in juxta-anastomotic stenosis of autologous arteriovenous fistula(AVF)of diabetic hemodialysis patients.Methods Diabetic patients with juxta-anastomotic stenosis in Beijing Tsinghua Changgung Hospital from February 2016 to December 2018 were retrospectively analyzed.The clinical data,success rate,patency time of PTA and vascular neo-anastomosis were compared.Results Thirteen patients received PTA,including 1 case of surgical failure and 1 case of thrombosis,and the success rate was 11/13.Vascular neo-anastomosis were performed in 15 cases,and 13 cases succeeded.The success rate was 13/15,and the success rate between two groups had no significant(P>0.05).The median patency time was 11(7-12)months and 15(5-22)months(P>0.05).The volume of bleeding[3(2-4)ml vs.20(10-40)ml],the length of blood vessel wastage[0 vs.(3.6±1.2)cm]and the operating time[(0.6±0.7)h vs.(1.8±0.5)h]of PTA patients were less than those of vascular neo-anastomosis group,and there were significant differences(P<0.05).Conclusions There are no significant differences between PTA and neo-anastomosis with respect to patency.PTA has the advantages of less vascular injury,shorter operation time,less bleeding and can dilate arteries at the same time.

关 键 词：糖尿病 血液透析滤过 自体动静脉内瘘 经皮球囊扩张 

分 类 号：R47[医药卫生—护理学]