两种不同术式治疗动静脉内瘘急性血栓的疗效分析  

Effectiveness of two different surgical methods for treatment of acute thrombosis in arterio-venous fistula

作　　者：郜同心 任建伟[1] 高艳[1] GAO Tong-xin;REN Jian-wei;GAO Yan(Department of Nephrology,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院肾内科,北京100012

出　　处：《临床肾脏病杂志》2020年第11期857-862,共6页Journal Of Clinical Nephrology

摘　　要：目的探讨动静脉内瘘切开取栓重建术与血管腔内成形术(percutaneous transluminal angioplasty,PTA)2种手术方式治疗血液透析患者前臂动静脉内瘘(arteriovenous fistulas,AVF)急性血栓的手术疗效。方法选取航空总医院2014年1月至2018年6月117例AVF血栓形成患者作为研究对象,回顾性的分析临床资料,117例患者中手术重建55例,62例患者采用PTA,比较两种术式的手术成功率和术后并发症发生率,治疗后的初级通畅率和次级通畅率,通过Kaplan-Meier分析评价通畅率。结果两组患者在平均年龄、内瘘平均使用寿命、和血栓形成时间方面比较差异无统计学意义(P>0.05),AVF切开取栓重建术手术55例,手术解剖成功率为96.3%,临床成功率为90.9%;术后3、6、12个月的初级通畅率分别为98.2%,92.7%及87.3%,次级通畅率分别为100.0%、98.2%、92.7%。血管腔内成形术手术62例,手术解剖成功率为91.9%,临床成功率88.7%,术后3、6、12个月的初级通畅率分别为93.5%,83.9%及72.5%。次级通畅率分别为100%、98.4%、93.5%。结论相较于PTA,外科手术重建术治疗前臂AVF血栓成功率高,复发率低,可延长内瘘生存时间,是治疗AVF血栓的有效方法。Objective To investigate the surgical effectiveness of arteriovenous fistula thrombectomy and reconstruction and percutaneous transluminal angioplasty(PTA)for the treatment of acute thrombosis in arterio-venous fistulas(AVFs)in the forearm in hemodialysis patients.Methods The clinical data of 117 hemodialysis patients with acute thrombosis in arterio-venous fistula,who were admitted to Aviation General Hospital during the period from January 2014 to June 2018,were retrospectively analyzed.Among 117 patients,55 cases were treated with fistula reconstruction surgery,62 cases were treated with PTA.Demographic data,surgical success rates and post-operative complication incidence,between the two surgical methods were compared.The primary patency and secondary patency rates were evaluated by Kaplan-Meier analysis.Results There were no significant differences between the two groups in the average age of patients,the average service life of internal fistula,and the thrombosis time(P>0.05).Of 55 cases subject to fistula reconstruction surgery,the surgical success rate was 96.3%and the clinical success rate was 90.9%;at 3,6 and 12 months after operation,the primary patency rate was 98.2%,92.7%and 87.3%,and the secondary patency rate was 100.0%,98.2%and 92.7%,respectively.In a total of 62 cases of PTA,success rate of operative anatomy was 91.9%,and clinical success rate was 88.7%;at 3,6 and 12 months after operation,primary patency rate was 93.5%,83.9%and 72.5%respectively,and secondary patency rate was 100%,98.4%and 93.5%respectively.There were no procedure-related major complications.Conclusions In comparison to PTA,fistula reconstruction surgery for treatment of AVF thrombosis has a high success rate and a low relapse rate,prolongs survival time,and is an effective method to treat arterio-venous fistula thrombosis.

关 键 词：血液透析 经皮腔内血管成形术 血管重建手术 血管通路 

分 类 号：R654.3[医药卫生—外科学]