前臂失功动静脉内瘘修复的临床研究

Clinical Study on Repairing Dysfunction of Forearm Arterioioveneous Fistular

目的：探讨维持性血液透析（MHD）患者前臂动静脉内瘘失功后修复的方法和疗效。方法：42例前臂动静脉内瘘失功的患者,29例开放手术修复,13例经皮血管成形术（PTA）修复。并用Kaplan-Meier法制作狭窄病变内瘘（伴或不伴血栓）修复后内瘘通畅的生存曲线,用Log Rank检验比较手术修复和介入修复后通畅率的差异。结果：随访1～18个月,手术组29例修复成功（100%）,PTA组12例修复成功（92%）,伴有狭窄的内瘘修复后瘘管的通畅率平均生存时间：手术修复组（16.811±0.803）月,介入修复组（6.092±0.787）月,Log Rank检验,χ^2=7.098,P=0.008,对伴有狭窄的内瘘,手术修复后通畅率显著高于介入修复后通畅率。结论：根据患者血管条件选择合适的手术位置和手术方式可较好的修复失功内瘘,通畅率较高;PTA修复内瘘有微创、方便、快捷的优势,但术后再狭窄发生率较手术组高,且对复杂病例应慎用。

Objective： To investigate the repair method of forearm arteriovenous fistula（ AVF） dysfunction in maintenance hemodialysis（ MHD） patients. Methods： There are 42 cases of patients with forearm AVF dysfunction,in which open operation repair in 29 cases,percutaneous transluminal angioplasty（ PTA） repair in 13 cases. Kaplan- Meier method was used to analyze of stenosis of AVF（ with or without thrombosis） survival curves after repaired fistula patency. Results： During the follow- up of 1- 18 months,29 cases of operation patients had successful restoration（ 100%）,and 12 cases（ 92%） in PTA group（ N = 13） got successful repair. Fistula stenosis after fistula patency rate of the average survival time： operation group（ 16. 811 ± 0. 803） months,involved group（ 6. 092 ± 0. 787） months,Log Rank inspection,χ^2= 7. 098,P = 0. 008,accompanied by a narrow fistula patency rate after operation,the patency rate was significantly higher than the intervention group. Conclusion： According to the selection of repair operation,position and suitable operation mode can be used in patients with dysfunction of fistula,the patency rate was higher; PTA repair fistula is minimally invasive,convenient,quick advantage,but the postoperative restenosis rate is higher than the operation group,it should be used with caution in complicated cases.