超声引导下球囊扩张术治疗动静脉内瘘狭窄的疗效观察

doi:10.11958/20252772

摘要/Abstract

摘要：

目的观察超声引导下球囊扩张术治疗动静脉内瘘狭窄的效果及再狭窄率。方法回顾性分析78例动静脉内瘘狭窄患者的临床资料，按手术方式的不同分组，将数字减影血管造影（DSA）下行球囊扩张治疗的38例患者纳入DSA组，将超声引导下球囊扩张术治疗的40例患者纳入超声引导组，观察2组患者一次穿刺成功率、手术用时、术中出血量、术后内瘘开始使用时间等手术情况，比较术后临床指标、术后再狭窄及术后并发症发生情况。结果超声引导组较DSA组一次穿刺成功率更高，手术用时更短（P<0.05），2组术中出血量、术后内瘘开始使用时间相比差异无统计学意义（P>0.05）；2组术后7 d的动静脉内瘘狭窄处内径大小、透析血流量、内瘘自然血流量、横截面积相较术前均升高（P<0.05）；术后7 d，超声引导组相较DSA组内径大小、透析血流量、内瘘自然血流量明显更高（P<0.05）；2组患者术后横截面积相比差异无统计学意义（P>0.05）；2组患者术后1个月内均无再狭窄发生，术后3个月的再狭窄率相比差异无统计学意义（P>0.05），超声引导组相较DSA组在术后6、9个月时的再狭窄率更低（P<0.05）；2组患者术后并发症总发生率比较差异无统计学意义（P>0.05）。结论超声引导下球囊扩张术治疗动静脉内瘘狭窄可有效改善狭窄处内径，手术用时少，提高透析血流量，且再狭窄风险低，术后并发症少。

关键词: 动静脉瘘, 动静脉内瘘狭窄, 超声引导下球囊扩张术, 再狭窄率

Abstract:

Objective To observe the effect and restenosis rate of ultrasound-guided balloon dilatation in the treatment of arteriovenous fistula stenosis. Methods The clinical data of 78 patients with arteriovenous fistula stenosis were retrospectively analyzed. The above patients were grouped by different surgical methods. Thirty-eight patients who received balloon dilatation under digital subtraction angiography (DSA) were included in the DSA group, and 40 cases who adopted ultrasound-guided balloon dilatation were enrolled as the ultrasound-guided group. The surgical conditions (success rate of one-time puncture, surgical time, intraoperative blood loss and postoperative fistula starting time) were observed in the two groups of patients. The postoperative clinical indicators, postoperative restenosis and occurrence of postoperative complications were compared. Results Compared with the DSA group, the success rate of one-time puncture, was higher, and the surgical time was shorter in the ultrasound-guided group (P<0.05), but there were no significant differences in the intraoperative blood loss and postoperative fistula starting time between the two groups (P>0.05). The internal diameter, dialysis blood flow volume, internal fistula natural blood flow and cross-sectional area of the arteriovenous fistula stenosis were increased at 7 days after surgery compared with those before surgery in the two groups (P<0.05). The internal diameter, dialysis blood flow volume and internal fistula natural blood flow in the ultrasound-guided group at 7 days after surgery were significantly higher than those in the DSA group (P<0.05). There was no significant difference in postoperative cross-sectional area between the two groups of patients (P>0.05). No restenosis occurred within 1 month after surgery in the two groups, and there was no significant difference in the restenosis rate at 3 months after surgery between the two groups of patients (P>0.05). The restenosis rates at 6 and 9 months after surgery were lower in the ultrasound-guided group than those in the DSA group (P<0.05). There was no statistical difference in total incidence rate of postoperative complications between the two groups of patients (P>0.05). Conclusion Ultrasound-guided balloon dilatation in the treatment of arteriovenous fistula stenosis can effectively improve the inner diameter of the stenosis, exhibit quick surgery and increase the dialysis blood flow volume. In addition, it has low risk of restenosis and few postoperative complications.

Key words: arteriovenous fistula, arteriovenous fistula stenosis, ultrasound-guided balloon dilatation, restenosis rate

中图分类号:

R459.5

图/表 6

参考文献 19

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组别		n	年龄/岁	性别（男/女）		透析时间/周
DSA组		38	57.89±4.51	18/20		18.20±6.69
超声引导组		40	57.48±3.98	22/18		17.80±5.28
t或χ²			0.436	0.454		0.296
组别	病程/周		原发疾病
组别	病程/周		高血压肾病	糖尿病肾病	慢性肾炎	其他
DSA组	3.12±0.70		14	14	9	1
超声引导组	3.31±0.54		13	17	8	2
t或χ²	1.343		1.033

组别		n	年龄/岁	性别（男/女）		透析时间/周
DSA组		38	57.89±4.51	18/20		18.20±6.69
超声引导组		40	57.48±3.98	22/18		17.80±5.28
t或χ²			0.436	0.454		0.296
组别	病程/周		原发疾病
组别	病程/周		高血压肾病	糖尿病肾病	慢性肾炎	其他
DSA组	3.12±0.70		14	14	9	1
超声引导组	3.31±0.54		13	17	8	2
t或χ²	1.343		1.033

组别	n	一次穿刺成功	手术用时/min	术中出血量/mL	术后内瘘开始使用时间/d
DSA组	38	32（84.21）	68.47±13.91	15.03±2.08	1.84±0.19
超声引导组	40	39（97.50）	62.10±13.06	14.18±2.08	1.79±0.15
t或χ²		4.213^＊	2.088^＊	1.813	1.306

组别	n	一次穿刺成功	手术用时/min	术中出血量/mL	术后内瘘开始使用时间/d
DSA组	38	32（84.21）	68.47±13.91	15.03±2.08	1.84±0.19
超声引导组	40	39（97.50）	62.10±13.06	14.18±2.08	1.79±0.15
t或χ²		4.213^＊	2.088^＊	1.813	1.306

组别		n		内径大小/mm
组别		n		术前				术后7 d		t
DSA组		38		1.29±0.17				3.03±0.22		49.664^＊
超声引导组		40		1.27±0.10				3.25±0.35		34.532^＊
t				0.510				3.300^＊
组别	透析血流量/（mL/min）
组别	术前						术后7 d				t
DSA组	160.38±7.57						251.06±10.02				44.617^＊
超声引导组	159.74±8.51						257.85±8.88				53.120^＊
t	0.348						3.170^＊
组别	内瘘自然血流量/（mL/min）
组别	术前						术后7 d				t
DSA组	287.48±10.68						472.19±24.02				47.848^＊
超声引导组	284.51±12.81						489.73±30.69				45.059^＊
t	1.108						2.802^＊
组别			横截面积/mm²
组别			术前		术后7 d				t
DSA组			3.00±0.84			14.71±4.64			15.881^＊
超声引导组			3.10±0.54			14.68±4.72			15.483^＊
t			0.701			0.032