彩超引导下球囊扩张在血管通路狭窄中的应用  

Application value of balloon dilation guided by color doppler ultrasound in vascular access stenosis

作　　者：陈超 刘莉华 高军 宫峰 马胜银[1] CHEN Chao;LIU Li-hua;GAO Jun;GONG Feng;MA Sheng-yin(Department of Nephrology,The Third Affiliated Hospital of Bengbu Medical College,Suzhou Anhui 234000,China)

机构地区：[1]蚌埠医学院第三附属医院肾内科,安徽宿州234000

出　　处：《蚌埠医学院学报》2020年第3期331-334,共4页Journal of Bengbu Medical College

基　　金：安徽省公益性研究联动计划项目(1704f0804050);蚌埠医学院科研专项计划(BYZX201602)。

摘　　要：目的:研究彩超引导下球囊扩张术与外科重建内瘘术在治疗动静脉内瘘吻合口近心端狭窄(距吻合口2 cm以内)时的疗效是否一致。方法:回顾性分析69例动静脉内瘘吻合口近心端狭窄病人,根据手术方式分为经皮腔内血管成形术(PTA)组(A组)36例,外科手术组(B组)33例。随访并比较2组第1、3、6个月的通畅率。结果:A组透析时间(4.11±3.06)年,临床成功率97%,技术成功率100%。B组透析时间(3.85±2.81)年,临床成功率94%,技术成功率100%。A组第1、3、6个月的通畅率高于B组(P>0.05)。术后2组并发症发生率差异无统计学意义(P>0.05)。术前及术后1个月的内瘘狭窄处血管内径与肱动脉血流量2组差异均无统计学意义(P>0.05),2组术后1个月的血管内径和血流量均明显大于术前(P<0.01)。结论:彩超引导下球囊扩张术与外科手术治疗动静脉内瘘吻合口近心端狭窄具有相同的疗效,因为前者具有操作简便,术后即可透析,保存病人血管资源等优势可以推荐作为动静脉内瘘吻合口近心端狭窄首选的治疗方式。Objective:To compare the efficacy between balloon dilatation guided by color ultrasound and surgical reconstruction in the treatment of hemodialysis autogenous fistula anastomotic proximal stenosis(within 2 cm from the anastomosis).Methods:The clinical data of 69 patients with arteriovenous fistula anastomotic proximal stenosis were retrospectively analyzed.The patients were divided into the group A(36) cases treated with percutaneous transluminal angioplasty(PTA)and group B(33 cases treated with revascularization surgery).The patency rates in two groups at 1,3 and 6 months of after treatment were evaluated.Results:The dialysis time,clinical success rate and technical success rate in group A were(4.11±3.06)years,97%and 100%,respectively.The dialysis time,clinical success rate and technical success rate in group B were(3.85±2.81)years,94%and 100%,respectively.The patency rates in A group at 1,3 and 6 months after treatment were higher than that in group B(P<0.05).There was no statistical significance in the incidence rate of complications between two groups(P>0.05).There was no statistical significance in the intravascular diameter of internal fistula stenosis and brachial artery blood flow between two groups before operation and after 1 month of operation(P>0.05).The blood vessel diameter and blood flow in two groups after operation were significantly greater than those before operation(P<0.01).Conclusions:The effects of balloon dilatation guided by color ultrasound and surgical reconstruction in the treatment of hemodialysis autogenous fistula anastomotic proximal stenosis are the same.The balloon dilatation guided by color ultrasound is simple,the patients can be dialysed after operation,the vascular resources can be preserved,so which can be recommended as the preferred treatment for arteriovenous fistula anastomotic proximal stenosis.

关 键 词：动静脉内瘘 吻合口近心端狭窄 超声 经皮经腔血管成形术 

分 类 号：R654.4[医药卫生—外科学]