置管溶栓联合球囊成形术治疗动静脉内瘘闭塞合并血管狭窄的临床观察  

Clinical observation of intra-arteriovenous fistula occlusion complicated with vascular stenosis treated by catheterization and thrombolysis combined with balloon plasty

作　　者：丁玲华 吴军[1] 王天义[1] 谢明媚[1] 吴腾南 严雄 Ding Linghua;Wu Jun;Wang Tianyi;Xie Mingmei;Wu Tengnan;Yan Xiong(Department of Nephrology,Anqing First People's Hospital,Anqing 246000,Anhui,China;Department of Interventional and Vascular Surgery,Anqing First People's Hospital,Anqing 246000,Anhui,China)

机构地区：[1]安庆市第一人民医院肾内科,安徽安庆246000 [2]安庆市第一人民医院介入与血管外科,安徽安庆246000

出　　处：《血管与腔内血管外科杂志》2024年第6期748-751,共4页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨置管溶栓联合球囊成形术治疗动静脉内瘘闭塞合并血管狭窄的临床疗效。方法收集2020年1月至2023年1月安庆市第一人民医院收治的70例动静脉内瘘闭塞合并血管狭窄患者的临床资料,按照治疗方案的不同将其分为溶栓组(n=32,采用置管溶栓治疗)和手术组(n=38,采用置管溶栓联合球囊成形术治疗)。比较两组患者治疗后24、48、72 h内瘘开通率,观察两组患者治疗前后血管狭窄段内径与血流量的变化,记录两组患者术后并发症发生率。结果治疗后24、48、72 h,手术组患者内瘘开通率均高于溶栓组患者,差异均有统计学意义(P﹤0.05)。手术组患者再次造瘘率为15.79%(6/38),低于溶栓组患者的65.63%(21/32),差异有统计学意义(P﹤0.05)。治疗后,两组患者治疗后狭窄血管内径、血流量均高于本组治疗前,且手术组患者狭窄血管内径、血流量均高于溶栓组患者,差异均有统计学意义(P﹤0.05)。手术组患者术后并发症总发生率为13.16%(5/38),与溶栓组患者的28.13%(9/32)比较,差异无统计学意义(P﹥0.05)。结论置管溶栓联合球囊成形术治疗动静脉内瘘合并血管狭窄可提高内瘘再通率,降低再次造瘘率,有效扩张狭窄血管内径,提高狭窄血管血流量,安全可行。Objective To investigate the clinical effect of thrombolysis combined with balloon plasty in the treatment of arteriovenous fistula occlusion complicated with vascular stenosis.Method Clinical data of 70 patients with arteriovenous fistula occlusion complicated with vascular stenosis admitted to Anqing First People's Hospital from January 2020 to January 2023 were collected.According to different treatment plans,they were divided into thrombolysis group(n=32,treated with catheterization thrombolytic therapy)and operation group(n=38,treated with catheterization thrombolytic therapy combined with balloon plasty).The rates of fistula opening within 24,48 and 72 h after treatment were compared between the two groups,the changes of the internal diameter and blood flow of the vascular stenosis segment before and after treatment were observed in the two groups,the incidence of complications after surgery was recorded.Result At 24,48 and 72 h after treatment,the fistula opening rate in operation group was higher than that in thrombolysis group,the differences were statistically significant(P<0.05).The rate of restomy in the surgery group was 15.79%(6/38),lower than that in the thrombolytic group of 65.63%(21/32),the difference was statistically significant(P<0.05).After treatment,the stenosis vessel diameter and blood flow in two groups after treatment were higher than those before treatment,and the stenosis vessel diameter and blood flow in surgery group were higher than those in thrombolytic group,with statistical significance(P<0.05).The total incidence of postoperative complications in the operation group was 13.16%(5/38),compared with 28.13%(9/32)in the thrombolytic group,there was no significant difference(P>0.05).Conclusion The treatment of arteriovenous fistula combined with balloon angioplasty can improve the rate of fistula reanastomosis,reduce the rate of restomy,effectively dilate the inner diameter of the narrow vessel,and increase the blood flow of the narrow vessel,which is safe and feasible.

关 键 词：动静脉内瘘 血管狭窄 置管溶栓 球囊成形术 

分 类 号：R543[医药卫生—心血管疾病]