经动、静脉途径介入治疗自体动静脉内瘘狭窄的临床效果分析  

Analysis of clinical effect of interventional treatment of arteriovenous fistula stenosis through arteriovenous approach

作　　者：宿敬存 夏化文 沈爱红[2] 王海洋 李军波 Su Jingcun;Xia Huawen;Shen Aihong;Wang Haiyang;Li Junbo(Department of Intervention surgery,Handan First Hospital,Hebei Province,Handan 056000,China;Department of Obstetrics and Gynecology,North District of 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6期524-528,共5页Clinical Medicine of China

基　　金：2019年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：目的比较经动脉途径和静脉途径两种方式治疗自体动静脉内瘘狭窄的临床效果和围手术期并发症的发生情况。方法收集邯郸市第一医院收治的AVF狭窄闭塞行介入治疗且符合入组标准的120例患者的临床资料,采用回顾性病例对照研究进行分析,其中2017年9月至2018年8月内瘘狭窄患者采用经动脉入路60例(动脉入路组),2018年9月至2019年5月应用新的手术方案即采用经静脉入路60例(静脉入路组)。比较两组患者的手术成功率、围手术期并发症的发生情况,术后3、6、12个月的通畅率。结果(1)动脉入路组技术成功率96.7%(58/60),临床成功率91.7%(55/60);静脉入路组技术成功率95.0%(57/60),临床成功率93.3%(56/60);两组的技术成功率、临床成功率比较差异均无统计学意义(P值分别为0.718、1.000)。(2)围手术期并发症:动脉途径组3例患者出现穿刺点处血肿,假性动脉瘤2例,血栓形成5例。静脉途径组3例患者发生血栓,两组并发症发生率比较,差异有统计学意义(χ2=4.227,P=0.036)。(3)动脉入路组术后3、6、12个月一期通畅率分别为95.0%(57/60)、75.0%(45/60)、60.0%(36/60),静脉入路组3、6、12个月一期通畅率分别为96.7%(58/60)、71.7%(43/60)、61.7%(37/60),两组比较差异无统计学意义(P值分别为0.718、0.749、0.885)。结论经动、静脉途径介入治疗AVF狭窄均能取得较好的疗效,经动脉途径围手术期并发症较多,建议首选静脉入路。Objective To compare the clinical effect and perioperative complications of the treatment of autogenous arteriovenous fistula stenosis by arterial and venous approach.Methods The clinical data of 120 patients with AVF stenosis and occlusion who were treated with interventional therapy and met the inclusion criteria were collected and analyzed by retrospective case-control study.from September 2017 to August 2018,60 patients with internal fistula stenosis were treated by transarterial approach(arterial approach group),and from September 2018 to may 2019,60 patients were treated with a new surgical scheme(venous approach group).The operation success rate,perioperative complications and patency rate of 3,6,12 months after operation were compared between the two groups.Results(1)The technical success rate was 96.7%(58/60)and the clinical success rate was 91.7%(55/60)in the arterial approach group,and 95.0%(57/60)and 93.3%(56/60)in the venous approach group.There was no significant difference in the technical success rate and clinical success rate between the two groups(P=0.718 and 1.000,respectively)(2)Perioperative complications:in the arterial approach group,3 patients had hematoma at the puncture point,2 pseudoaneurysms and 5 thrombosis.There were 3 patients with thrombosis in the venous access group,and the difference in the incidence of complications between the two groups was statistically significant(χ2=4.227,P=0.036).(3)The primary patency rates at 3,6 and 12 months after operation were 95.0%(57/60),75.0%(45/60)and 60.0%(36/60)in the arterial approach group,and 96.7%(58/60),71.7%(43/60)and 61.7%(37/60)in the venous access group,respectively.There was no statistically significant difference between the two groups(P=0.718,0.749,0.885).Conclusion The interventional treatment for autogenous arteriovenous fistula stenosis through artery and vein approach can achieve good effect.There were many complications during the perioperative period,It is suggested that venous approach is preferred.

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 动脉途径 静脉途径 

分 类 号：R692.5[医药卫生—泌尿科学]