50例次PTFE人造血管术后存活率及并发症分析

Retrospective Analysis of 50 Cases Polytetrafluorothylene Grafts

目的 评估PTFE(polytetrafluorothylene)人造血管作为一种次选的血管通路 ,其通畅率、并发症及其相关影响因素。方法 对 41例慢性透析患者所进行的 50例次PTFE置管术进行回顾性分析。结果 41例患者中糖尿病患者 1 8例 ,非糖尿病患者 2 3例 ,均有此前 1次或以上自体动静脉内瘘失败史。在 50例次PTFE手术中 ,上肢为 36例次 ,下肢 1 3例次 ,锁骨下 1例次。 50例次PTFE人造血管 0 .5、1、2年的累积生存率分别为65 .66 % ,61 .2 1 %及 43 .72 %。糖尿病与非糖尿病患者 ,上肢前臂与下肢人造血管的累积生存率无显著差异(P >0 .0 5)。人造血管术后并发症以血栓形成最为常见 (31例次 ) ,其他尚包括假性动脉瘤、感染、人造血管外露、血清瘤、出血 ,充血性肿胀等。结论 PTFE人造血管对无法建立自体动静脉内瘘的慢性透析患者有一定的辅助作用 。

Purpose: To evaluate the patency, complications and other corresponding factors related with polytetrafluorothylene (PTFE) grafts as a secondary hemodialysis vascular access. Methods: A retrospective analysis was conducted on 50 cases PTFE grafts in 41 patients placed by one experienced vascular surgeon in one hospital during the period from Oct 1997 to Oct 2000. Results: There were 25 female and 16 male patients with a median age (63 ± 10) years (range 28-81 years). Eighteen patients were diabetes while 23 were non-diabetes. All patients had previous creations of native A-V fistulas (AVF) before the placement of PTFE grafts. Thirty-six cases were over upper forearms, 13 cases were over lower extremities and 1 case over subclavic. The 0.5, 1,2 years cumulative patency rates of the 50 PTFE grafts was 65.66%, 61.21% and 43.72% respectively. There was no significant difference of the patency rates between the diabetic and non-diabetic patients (P > 0.05) and between the upper forearm and lower extremities grafts (P > 0.05). Complications include graft thrombosis (31 cases), pseudoanurism (7 cases), infection (5 cases), graft exposure (3 cases), seroma (2 cases), bleeding (1 case) and venous congestion (1 case). Conclusions: PTFE grafts offer an alternative vascular access for chronic hemodialysis patients, but considering their patency rates and complication profile, the native arteriovenous fistula should continue to be the first choice procedure.