自体动静脉内瘘阻塞介入治疗疗效和术后通畅率影响因素分析  

Analysis of therapeutic effect and influencing factors of postoperative patency rate in the patients with autologous arteriovenous fistula obstruction treated with interventional therapy

作　　者：陈立洲 姚立正[1] 李文会[1] 朱军[1] 万豪光[1] CHEN Lizhou;YAO Lizheng;LI Wenhui;ZHU Jun;WAN Haoguang(Department of Interventional Radiology, Yancheng Third People Hospital, Yancheng 224000, China)

机构地区：[1]江苏省盐城市第三人民医院介入放射科,江苏盐城224000

出　　处：《医学影像学杂志》2022年第3期500-504,共5页Journal of Medical Imaging

摘　　要：目的分析自体动静脉内瘘(AVF)阻塞介入治疗疗效和术后通畅率影响因素。方法选取本院接受介入治疗的78例AVF阻塞患者,经引流静脉行血管成形术。观察技术成功率和并发症,术后随访AVF通畅情况,对AVF通畅率的影响因素进行单因素和多因素分析。结果78例患者均顺利完成手术,技术成功率100.0%。单纯球囊扩张术64例(82.1%),球囊扩张联合置管溶栓术14例(17.9%)。未出现严重的手术相关并发症,2例(2.6%)扩张吻合口狭窄时出现血管破裂,未导致严重后果;4例(5.1%)出现穿刺点出血,经重新加压包扎后缓解。术后随访1~44个月,中位随访时间22个月,随访期间共有38例阻塞复发,其中20例再次接受介入治疗。患者6个月、1年、2年和3年一期累积通畅率分别为92.2%、81.3%、43.6%和33.1%,二期累积通畅率分别为97.4%、91.9%、52.5%和43.9%。单因素分析显示,年龄≤60岁组、无糖尿病组和单发狭窄组介入治疗术后AVF通畅率分别高于年龄>60岁组、糖尿病组和多发狭窄组(P<0.05);而通畅率与性别、AVF位置及是否吻合口及附近阻塞、静脉穿刺段阻塞、动脉端阻塞和血栓形成无关(P>0.05)。Cox多因素分析显示,糖尿病是介入治疗术后AVF通畅率的独立危险因素(P<0.05)。结论AVF阻塞行介入治疗是安全、有效的,值得临床推广应用。糖尿病是AVF阻塞介入治疗术后通畅率的独立危险因素。Objective To analyse the therapeutic effect and influencing factors of postoperative patency rate in the patients with autologous arteriovenous fistula(AVF)obstruction treated with interventional therapy.Methods Totally,78 patients with AVF obstruction who received interventional treatment in our hospital were retrospectively selected.Angioplasty through the drainage vein was performed.The technical success rate and complications were observed,and the patency of AVF was followed up after surgery.Univariate and multivariate analysis were performed on the influencing factors of patency of AVF.Results Totally,78 patients were successfully completed the operation,and the technical success rate was 100.0%.64 cases(82.1%)were treated with balloon dilatation alone,and 14 cases(17.9%)were treated with balloon dilation combined with catheter thrombolysis.There were no serious complications related to surgery.Two patients(2.6%)had ruptured blood vessels during dilated anastomotic stenosis,which did not cause serious consequences.Four patients(5.1%)had bleeding at the puncture site,which was relieved after re-compressing and dressing.The follow-up period ranged from 1 to 44 months after operation,with a median follow-up period of 22 months.During the follow-up period,a total of 38 patients had obstruction recurrence,of whom 20 patients received interventional therapy again.The 6-month,1-year,2-year,and 3-year first-phase cumulative patency rates of the patients were 92.2%,81.3%,43.6%,and 33.1%,respectively,and the second-phase cumulative patency rates were 97.4%,91.9%,52.5%,and 43.9%,respectively.Univariate analysis showed that the AVF patency rate after interventional therapy in the age≤60 years group,the non-diabetic group and the single stenosis group were higher than those in the age>60 years group,the diabetes group and the multiple stenosis group(P<0.05).The patency rate had nothing to do with gender,AVF location and whether or not the anastomosis and the nearby obstruction,venous puncture segment obstruction,arteri

关 键 词：自体动静脉内瘘 介入治疗 通畅率 影响因素 介入性 放射学 

分 类 号：R654.4[医药卫生—外科学] R816.2[医药卫生—临床医学]