超声引导下经皮腔内血管成形术对尿毒症伴上肢自体动静脉内瘘狭窄患者内瘘通畅情况、再狭窄发生的影响

Effect of Ultrasound-guided Percutaneous Balloon Dilation on the Patency and Restenosis of Upper Limb Autologous Arteriovenous Fistula Stenosis in Patients with Uremia

目的分析超声引导下经皮球囊扩张术(PTA)对尿毒症伴上肢自体动静脉内瘘(AVF)狭窄患者的临床效果.方法回顾性分析2018年11月—2022年1月我院收治的66例尿毒症伴上肢AVF狭窄患者的临床资料,按治疗方式的不同将患者分为两组.其中,行常规外科手术治疗的31例患者作为对照组,行超声引导下经皮腔内血管成形术(PTA)治疗的35例患者作为观察组,术后持续随访1年.对比两组患者手术相关指标、内瘘通畅情况、并发症、再狭窄发生率.结果观察组患者手术时间为(87.57±25.45)min、住院时间为(2.60±1.26)d、并发症发生率为5.71%、再狭窄发生率为5.71%、对照组患者手术时间为(143.29±87.56)min、住院时间为(13.12±8.85)d、并发症发生率为29.03%、再狭窄发生率为16.13%,组间差异有统计学意义(P<0.05).两组内瘘通畅率相比,差异无统计学意义(P>0.05).术前,两组狭窄处内径、肱动脉血流量、透析血流量相比,组间差异无统计学意义(P>0.05);术后,观察组狭窄处内径为(3.95±0.48)mm,长于对照组的(3.36±0.57)mm,肱动脉血流量为(951.57±106.275)mL/min、透析血流量为(254.29±10.92)mL/min,多于对照组的(840.84±388.94)mL/min、(232.25±32.53)mL/min,组间差异有统计学意义(P<0.05).结论超声引导下PTA治疗尿毒症伴上肢AVF狭窄患者效果显著,能够缩短手术、住院时间,改善内瘘血流量,且并发症与再狭窄发生率较低,具有一定的应用价值,值得临床进行推广.

Objective To analyze the clinical effect of ultrasound-guided percutaneous balloon dilatation(PTA)in the treatment of autologous arteriovenous fistula(AVF)stenosis in maintenance hemodialysis(MHD)uremic patients.Methods The clinical data of 66 patients with uremia complicated with upper limb AVF stenosis treated in our Hospital from November 2018 to January 2022 were retrospectively analyzed.According to the different treatment methods,the patients were divided into two groups.Among them,31 patients who underwent conventional surgical treatment were selected as the control group,and 35 patients who underwent ultrasound-guided PTA treatment were selected as the observation group.Continuous followup for 1 year after surgery.The operation related indicators,the patency of internal fistula,complications,and the incidence of restenosis were compared between the two groups.Results The observation group had a surgical time of(87.57±25.45)minutes,hospital stay of(2.60±1.26)days,complication rate of 5.71%,and restenosis rate of 5.71%,the control group had a surgical time of(143.29±87.56)minutes,hospital stay of(13.12±8.85)days,complication rate of 29.03%,and restenosis rate of 16.13%,the difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in the patency rate of internal fistula between the two groups(P>0.05).Before operation,there was no significant difference in the diameter of stenosis,brachial artery blood flow and dialysis blood flow between the two groups(P>0.05);after operation,the internal diameter of the stenosis in the observation group was(3.95±0.48)mm,which was longer than(3.36±0.57)mm in the control group,the blood flow of the humeral artery was(951.57±106.275)mL/min,and the dialysis blood flow was(254.29±10.92)mL/min,which were more than(840.84±388.94)mL/min and(232.25±32.53)mL/min in the control group,and the difference between groups was statistically significant(P<0.05).Conclusion The effect of ultrasound-guided PTA in the treatment of uremia with upper limb AVF stenosis is significant,which can shorten the operation and hospitalization time,improve the internal fistula patency rate,improve the internal fistula blood flow,and have a low incidence of complications and restenosis,which has certain application value and is worthy of clinical promotion.