球囊渐进扩张法治疗动静脉内瘘CTO病变的研究  

Study on the treatment of arteriovenous fistula with CTO by the balloon progressive dilation technology

作　　者：熊狄 周颖[1] 冯剑[2] 万珍 刘飞燕[1] 陈慧敏 XIONG Di;ZHOU Ying;FENG Jian;WAN Zhen;LIU Feiyan;CHEN Huimin(Department of Dialysis,the Third Hospital Affiliated to NanChang University,Nanchang,Jiangxi 330006,China;Department of Nephrology,Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital,Hangzhou,Zhejiang 310020,China)

机构地区：[1]南昌大学第三附属医院血液透析室,南昌330006 [2]浙江大学医学院附属邵逸夫医院肾内科,杭州310020

出　　处：《重庆医学》2021年第18期3131-3135,共5页Chongqing medicine

基　　金：江西省科技厅重点研发计划(20192BBG70032)。

摘　　要：目的探讨球囊渐进扩张法治疗动静脉内瘘慢性完全闭塞(CTO)病变的安全性和有效性。方法选取2019年1月至2020年6月120例动静脉内瘘功能丧失患者为研究对象,分为试验组、对照A组和对照B组,试验组采用球囊渐进扩张法对内瘘CTO病变患者进行治疗,对照A组则采用双导丝法,对照B组采用多导丝挤压斑块法,观察并比较各组手术效果和并发症发生情况。结果采用经皮腔内血管成形术(PTA)治疗时使用多种技术后开通动静脉内瘘CTO病变的总体技术成功率为73.3%,总体临床成功率为70.8%,总体并发症发生率为29.2%。试验组技术成功率(72.5%)和临床成功率(70.0%)高于对照A组及对照B组,差异有统计学意义(P<0.05)。对于导丝能通过而球囊不能通过的内瘘CTO病变,试验组成功率达93.5%,较对照A组及对照B组具有更明显的优势(P<0.05)。无论采用何种技术开通CTO病变,术后肱动脉血流量及3、6个月内瘘通畅率比较,差异均无统计学意义(P>0.05)。结论球囊渐进扩张法能够安全、有效地开通动静脉内瘘CTO病变,尤其是在导丝能通过但球囊不能通过的病例中。Objective To explore the safety and effectiveness of the balloon progressive dilation technology in the treatment of chronic total occlusion(CTO)of internal arteriovenous fistula.Methods From January 2019 to June 2020,120 patients with arteriovenous fistula failure were selected as the research objects,and they were divided into the experiment group,the control group A and the control group B.The experiment group used the balloon progressive dilation technology to treat patients with CTO of internal fistula,the control group A was treated with the double-guide wire method,and the control group B was treated with the multi-guide wire plaque squeeze method.The surgical effects and complications of each group were observed and compared.Results The overall technical success rate of opening arteriovenous fistula CTO lesions after using multiple techniques during percutaneous transluminal angioplasty(PTA)treatment was 73.3%,the overall clinical success rate was 70.8%,and the overall complication rate was 29.2%.The technical success rate(72.5%)and clinical success rate(70.0%)in the experiment group were higher than those in the control group A and B,the difference was statistically significant(P<0.05).For the internal fistula CTO lesions that the guide wire could pass while the balloon could not pass,the test composition power reaches 93.5%,which had a more obvious advantage than the control group A and B(P<0.05).Regardless of the technique used to open CTO lesions,there was no statistically significant difference in the postoperative brachial artery blood flow and the fistula patency rate within 3 and 6 months(P>0.05).Conclusion The balloon progressive dilation technology can safely and effectively treat arteriovenous fistula CTO lesions,especially incases where the guide wire can pass but the balloon cannot pass.

关 键 词：血液透析 动静脉内瘘 慢性完全闭塞性病变 经皮腔内血管成形术 球囊渐进扩张法 

分 类 号：R692.5[医药卫生—泌尿科学]