经静脉途径介入治疗自体动静脉内瘘狭窄的临床效果及并发症防治分析  

Analysis of clinical effect and complication prevention and treatment of autogenous arteriovenous fistulas stenosis by intravenous intervention therapy

作　　者：宿敬存 夏化文 王海洋 李军波 沈爱红[2] Su Jingcun;Xia Huawen;Wang Haiyang;Li Junbo;Shen Aihong(Department of Interventional Surgery,Handan First Hospital,Hebei Province,Handan 056000,China;Department of Obstetrics and Gynecology,North District,Jizhong Energy Fengfeng Group Hospital,Handan 056000,China)

机构地区：[1]河北省邯郸市第一医院介入外科,056000 [2]冀中能源峰峰集团总医院北院区妇产科,河北省邯郸市056000

出　　处：《中国综合临床》2020年第5期431-434,共4页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划项目(20191800);邯郸市科学技术研究与发展计划项目(1823208076ZC)。

摘　　要：目的探讨经静脉途径介入治疗自体动静脉内瘘(autologous arteriovenous fistula,AVF)狭窄的临床疗效及安全性。方法选取2017年7月至2018年9月河北省邯郸市第一医院收治的96例自体动静脉内瘘狭窄闭塞患者的临床资料进行回顾性分析,均为慢性肾功能衰竭透析患者。所有患者均经头静脉途径行经皮球囊扩张血管成形术治疗。观察技术成功率和临床成功率、围手术期并发症的发生及随访情况。结果(1)技术成功率和临床成功率:90例患者均采用头静脉途径行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗,其余3例患者改用肱动脉入路行介入治疗,3例患者行内瘘重建术。技术成功率93.8%(90/96),临床成功率89.6%(86/96)。(2)围手术期并发症:血栓形成4例,血管痉挛3例。无血管破裂、动脉瘤、血管夹层等严重并发症发生,无围手术期死亡病例。(3)一期通畅率:术后3、6、12、18个月一期通畅率分别为100%(90/90)、74.4%(67/90)、62.2%(56/90)、46.7%(42/90)。结论静脉途径介入治疗AVF狭窄,创伤小,无严重并发症发生,术后穿刺点无需长时间压迫,可即刻进行透析,并能避免动脉穿刺引起的局部血肿等并发症,可做为AVF狭窄介入治疗的首选手术入路。Objective To explore the clinical effect and safety of interventional treatment of autogenous arteriovenous fistula(AVF)stenosis.Methods From July 2017 to September 2018,96 patients with arteriovenous fistula stenosis and occlusion admitted to Handan First Hospital,Hebei Province were retrospectively analyzed.All of them were dialysis patients with chronic renal failure.All patients underwent percutaneous balloon angioplasty via the cephalic vein.The success rate of technique,clinical success rate,perioperative complications and follow-up were observed.Results(1)Technical success rate and clinical success rate:90 patients were treated with percutaneous transluminal angioplasty(PTA)via the cephalic vein,the other 3 patients were treated with interventional therapy via the brachial artery,and 3 patients underwent reconstruction of internal fistula.The technical success rate was 93.8%(90/96),and the clinical success rate was 89.6%(86/96).(2)Perioperative complications:thrombosis in 4 cases,vasospasm in 3 cases.There were no serious complications such as vascular rupture,aneurysm,vascular dissection,and no perioperative death.(3)The first stage patency rate was 100%(90/90),74.4%(67/90),62.2%(56/90)and 46.7%(42/90)in 3,6,12 and 18 months after operation.Conclusion Venipuncture can be used as the first choice for AVF stenosis interventional therapy because of its advantages of small trauma,no serious complications,no need of long-term compression at the puncture point,immediate dialysis,and avoidance of local hematoma and other complications caused by artery puncture.

关 键 词：慢性肾功能衰竭 自体动静脉内瘘 经皮穿刺血管腔内成形术 

分 类 号：R692.5[医药卫生—泌尿科学]