自体血管补片成形术与经皮腔内血管成形术治疗血液透析患者自体动静脉内瘘狭窄的对比研究  

A comparative study of autologous vascular patch angioplasty and percutaneous transluminal angioplasty in the treatment of autologous arteriovenous fistula stenosis in hemodialysis patients

作　　者：王彦江 杜艳彬 王建丽 冯胜刚 WANG Yanjiang;DU Yanbin;WANG Jianli;FENG Shenggang(Department of Nephrology,Beijing Anzhen Nanchong Hospital of Capital Medical University,Nanchong Central Hospital,Nanchong 637001,Sichuan,China;General Practice Department,Beijing Anzhen Nanchong Hospital of Capital Medical University,Nanchong Central Hospital,Nanchong 637001,Sichuan,China)

机构地区：[1]首都医科大学附属北京安贞医院南充医院·南充市中心医院肾内科,四川南充637001 [2]首都医科大学附属北京安贞医院南充医院·南充市中心医院全科医学科,四川南充637001

出　　处：《西部医学》2025年第3期452-456,462,共6页Medical Journal of West China

基　　金：四川省基层卫生事业发展研究中心2024年课题(SWFZ24-Y-18);南充市科学技术局2022年第二批市级科技计划项目(22JCYJPT0014);南充市社科研究“十四五”规划2023年度项目(NC23B025)。

摘　　要：目的探讨自体血管补片成形术与超声引导下经皮腔内血管成形术(PTA)在维持性血液透析(MHD)患者自体动静脉内瘘(AVF)狭窄的疗效和患者负担,为治疗方式的选择提供依据。方法选取2022年6月—2023年6月南充市中心医院血液净化中心自体AVF狭窄收治的患者70例,按手术方式的不同,随机分为观察组与对照组,每组35例。观察组接受自体血管补片成形术,对照组接受超声引导下PTA。比较两组间术前及术后AVF狭窄部位的内径、肱动脉自然血流量、血液透析泵控流量、静脉压、手术并发症、住院费用及不同时间点(3、6、9月)的初级通畅率和次级通畅率。结果与术前相比,两组患者术后的血液透析泵控流量、狭窄血管内径以及肱动脉自然血流量均显著升高,术后的静脉压以及肱动脉阻力指数均显著降低(P<0.05)。与对照组相比,观察组的住院费用显著降低(P<0.05)。对照组无出血情况发生,观察组出血的发生率为17.14%,差异具有统计学意义(P<0.05);但两组总的并发症发生率比较无统计学差异(P>0.05)。两组患者术后即刻技术成功率和临床成功率均为100%;与对照组相比,观察组术后的3、6月初级通畅率较高,但无统计学差异(P>0.05);观察组9月的初级通畅率显著高于对照组(P<0.05);两组患者的3、6、9月的次级通畅率相比,均无统计学差异(P>0.05)。观察组内3、6、9月的次级通畅率较初级通畅率均升高,但无统计学差异(P>0.05)。对照组内3月次级通畅率高于其初级通畅率,但无统计学差异(P>0.05);6、9月的次级通畅率显著高于其初级通畅率(P<0.001)。结论自体血管补片成形术在AVF狭窄应用中的疗效确切,较PTA术远期通畅率更高、花费更低,是治疗AVF狭窄的一种可行治疗方式。Objective To provide the evidence for the selection of treatment methods by comparing the therapeutic efficacy and burden with patients of autologous vascular patch angioplasty and ultrasound-guided percutaneous transluminal angioplasty(PTA)in treating stenosis of autologous arteriovenous fistulas(AVF)in maintenance hemodialysis(MHD)patients.Methods Seventy patients with AVF stenosis treated at Nanchong Central Hospital's blood purification center from June 2022 to June 2023 were selected and randomly divided into an experimental group and a control group based on surgical methods.The experimental group underwent autologous vascular patch angioplasty,while the control group received ultrasound-guided PTA.The inner diameter of the stenotic site of the AVF,natural blood flow of the brachial artery,pump-controlled flow rate of hemodialysis,venous pressure,surgical complications,hospitalization costs,and primary and secondary patency rates at different time points(3 months,6 months,and 9 months)were compared between the two groups before and after surgery.Results Compared with pre-surgery,the pump-controlled flow rate of hemodialysis,inner diameter of the stenotic vessel,and natural blood flow of the brachial artery significantly increased in both groups post-surgery,while venous pressure and brachial artery resistance index significantly decreased(P<0.05).Compared with the hospitalization expenses of the control group,the hospitalization expenses of the experimental group were significantly reduced(P<0.05).There was no bleeding in the control group,while the incidence of bleeding in the experimental group(17.14%)showed a statistically significant difference(P<0.05);However,there was no statistically significant difference in the overall incidence of complications between the two groups(P>0.05).The immediate technical and clinical success rates of both groups of patients after surgery were 100%;Compared with the initial patency rates at 3 months(85.71%)and 6 months(77.14%)in the control group,the experimental group h

关 键 词：补片成形术 球囊扩张成形术 血液透析 自体动静脉内瘘 内瘘狭窄 

分 类 号：R692.5[医药卫生—泌尿科学]