即穿型人工血管夹层的诊断与治疗方式选择  

The diagnosis and treatment of early cannulation arteriovenous graft dissection

作　　者：倪其泓[1] 赵意平[1] 王韦仑 杨硕菲[1] 张岚[1] 陈佳佺[1] NI Qi-hong;ZHAO Yiping;WANG Wei-lun;YANG Shuo-fei;ZHANG Lan;CHEN Jia-quan(Department of Vascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200127

出　　处：《中国血液净化》2022年第3期210-212,217,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(82000447);上海交通大学医学院附属仁济医院培育基金(PYII-17-012);仁济医院科研种子基金(RJZZ19-10)。

摘　　要：目的总结即穿型人工血管夹层的诊断、治疗方式的选择及不同治疗方式的临床疗效。方法回顾性分析上海交通大学医学院附属仁济医院2017年8月~2020年12月收治的86例移植物动静脉内瘘(arteriovenousgraft,AVG)手术后患者的临床资料,统计分析患者的基础信息、手术前超声表现、病变部位、治疗方式和随访结果。结果4例发生夹层的患者首次治疗均采用经皮血管腔内成形术(percutaneous transluminal angioplasty,PTA)治疗,技术成功率与临床成功率均为100%(4/4)。所有患者均获随访,平均随访时间为(13.8±8.0)个月,手术后3月和手术后6月的一期通畅率为50%(2/4)和25%(1/4)。4例患者在随访过程中均再次行手术治疗,其中3例患者于AVG夹层处置入覆膜支架,支架置入手术后3月和手术后6月的一期通畅率均为100%(3/3),另1例患者行人工血管置换,随访9个月过程中AVG通畅。结论人工血管夹层是血液透析患者较为少见的并发症,经皮腔内血管成形术治疗的通畅时间短,覆膜支架置入或人工血管置换具有良好的通畅率,可取得满意的治疗效果。Objective To summarize the diagnosis,treatment and clinical effects of different treatment methods for early cannulation arteriovenous graft dissection.Methods The clinical data of 86 patients with arteriovenous graft(AVG)and treated with surgery in our center from August 2017 to December 2020 were retrospectively studied.Their basic information,preoperative ultrasound findings,lesion location,treatment method and follow-up results were statistically analyzed.Results All of the 4 patients with early cannulation AVG dissection were treated with percutaneous transluminal angioplasty(PTA)at first.The technical success rate and clinical success rate were 100%.They were followed up with the median follow-up time of 13.8±8.0 months.The primary patency rates after the surgery for 3 months and 6 months were 50%and 25%respectively.During the follow-up period,all of the 4 patients underwent surgical treatment again;3 of them were treated with stent graft,and the primary patency rates after stent implantation for 3 months and 6 months were 100%;one of them underwent AVG replacement,and the AVG was patent in the follow-up period of 9 months.Conclusion Dissection is a rare complication in hemodialysis patients with AVG for blood access.PTA results in a patency AVG only a short period of time.Stent graft implantation or AVG replacement achieves a better patency rate and satisfactory treatment effects.

关 键 词：即穿型 人工血管 夹层 诊断 治疗方式 

分 类 号：R318.16[医药卫生—生物医学工程]