超声导引经皮腔内血管成形术治疗自体动静脉内瘘狭窄的效果  

The efficacy of ultrasound-guided percutaneous transluminal angioplasty in the treatment of autologous arteriovenous fistula stenosis

作　　者：代恩 何小勤 杨敏[1] 李志 DAI En;He Xiaoqin;YANG Min;LI Zhi(Department of Nephrology,Leshan Municipal Shizhong District People’s Hospital,Leshan,Sichuan Province 614000,China)

机构地区：[1]乐山市市中区人民医院肾内科,四川乐山614000

出　　处：《介入放射学杂志》2023年第3期258-261,共4页Journal of Interventional Radiology

摘　　要：目的 探讨超声导引经皮腔内血管成形术(PTA)治疗自体动静脉内瘘(AVF)狭窄的临床疗效,分析术后通畅率影响因素。方法 收集2020年1月至12月在乐山市市中区人民医院接受超声导引PTA治疗的32例AVF狭窄患者临床资料。比较手术前后血管狭窄处内径、肱动脉血流量、AVF自然血流量和透析血流量等测量值。计算术后随访3、6、12个月初级通畅率。采用Cox比例风险回归模型分析影响初级通畅率的因素。结果 术后AVF血管原狭窄处内径明显增大,肱动脉血流量、AVF自然血流量和透析血流量均明显增加,与术前相比差异有统计学意义(均P<0.01)。PTA手术成功率为93.8%(30/32),2例改行开放手术后AVF重建成功。术后3、6、12个月累计初级通畅率分别为90.0%、76.7%、69.7%。单因素及多因素Cox比例风险回归模型分析显示,AVF使用时间(HR=3.478, 95%CI=1.105~10.127,P=0.036)、狭窄长度>3 cm(HR=3.149, 95%CI=1.682~10.128,P=0.018)是初级通畅率的独立影响因素。结论 PTA是AVF狭窄患者首选治疗方法,手术成功率高、近期效果好,中远期疗效有待进一步提高。AVF使用时间、狭窄长度>3 cm是术后初级通畅率的独立影响因素。Objective To investigate the clinical efficacy of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of autologous arteriovenous fistula(AVF)stenosis,and to analyze the factors influencing the postoperative patency rate.Methods The clinical date of a total of 32 patients with AVF stenosis,who received ultrasound-guided PTA at the Leshan Municipal Shizhong District People's Hospital of China between January and December of year 2020 were collected.The postoperative inner diameter at the vascular stenosis,blood flow of brachial artery,natural blood flow in AVF and dialytic blood flow were compared with preoperative ones.The postoperative 3-,6-and 12-month primary patency rates were calculated.Cox proportional hazards regression model was used to analyze the related factors affecting the primary patency of AVF after PTA.Results After operation,the inner diameter of the original stenosis site of AVF was significantly increased,and all the blood flow of brachial artery,natural blood flow in AVF,and dialytic blood flow were remarkably increased,which were statistically significant when compared with the preoperative data(all P<0.01).The successrate of PTA was 93.75%(30/32),and successful reconstruction of AVF with open surgery was achieved in 2 patients.The postoperative 3-,6-and 12-month cumulative primary patency rates were 90.0%,76.7%and 69.7%respectively.Univariate and multivariate Cox proportional hazards regression model analysis showed that the used time of AVF(HR=3.478,95%CI=1.105-10.127,P-0.036)and the length of stenosis>3 cm(HR=3.149,95%CI=1.682-10.128,P=0.018)were the independent factors affecting the primary patency rate after PTA.Conclusion PTA is the preferred treatment for patients with AVF stenosis.It has high success rate and good short-term effect.The mid-to-long-term efficacy needs to be further improved.The used time of AVF and the length of stenosis>3 cm are the independent factors affecting the primary patency rate after PTA.

关 键 词：自体动静脉内瘘 血管狭窄 经皮腔内血管成形术 初级通畅 COX比例风险回归模型 

分 类 号：R459.5[医药卫生—治疗学]