158例次人工血管动静脉内瘘术后并发症与长期通畅率

The long-term patency and postoperative complications of arteriovenous graft

目的评价终末期肾病患者采用人工血管建立动静脉内瘘(AVG)的长期通畅率、术后并发症及处理。方法对2012年4月至2016年7月在本中心行AVG术的155例患者的病例资料进行回顾性分析。观察术后并发症的情况和统计术后初级通畅率、辅助初级通畅率及次级通畅率。结果本组患者共建立158例次AVG,技术成功率为100%。围术期死亡率为0,平均随访时间18.9(3~56)个月。初级通畅期平均13.6(1~37)个月,1年初级通畅率为72.13%,1年辅助初级通畅率为83.61%,1年次级通畅率为98.36%。2年初级通畅率为43.10%,2年辅助初级通畅率为44.83%,2年次级通畅率为93.10%。随访期间内,149例患者术后出现不同程度的肢体肿胀,3.2周左右消退。55例患者发生内瘘狭窄(121例次),38例患者血栓形成(61例次)。38例患者和15例患者分别出现Ⅰ期和Ⅱ期窃血综合征。假性动脉瘤4例,感染2例。结论 AVG术后并发症整体可控,经过积极处理也具有较高的次级通畅率,是无法建立AVF时重要的替代选择。但是AVG长期初级通畅率目前并不高,随访维护成本较高,AVG术前应对患者和家属进行充分告知,使其对AVG有合理的预期。

Objective To review the long-term patency,postoperative complications and the treatment of arteriovenous graft(AVG) in patients with end stage renal disease.Methods From April 2012 to July2016,155 patients of PTFE hemodialysis access were followed up.Postoperative complications were observed,and primary patency,assisted primary patency,and secondary patency were calculated.Results Overall,158 cases of AVG were established in 155 patients,with a technical success rate of 100%.The perioperative death rate was 0%,and the average time of follow-up was 18.9 months(3~56 months).The average time of primary patency was 13.6(1~37) months.The 1-year primary patency rate was 72.13%,1-year assisted primary patency rate was 83.61%,1-year secondary patency rate was 98.36%.The 2-year primary patency rate was 43.10%,2-year assisted patency rate was 44.83%,and 2-year second patency rate was 93.10%.During the follow-up,149 patients had limb swelling,which disappeared in about 3.2 weeks.Postoperative complications included infection(2 cases),pseudoaneurysm(4 cases),thrombosis(38 cases),stenosis(55 cases) and steal syndrome(levelⅠ:38 cases,level Ⅱ:15 cases).Conclusion To establish AVG for patients without suitable access for autologous arteriovenous fistula is feasible,optimal preparation and evaluation of blood vessels before operation may improve the operation success rate and reduce the complication.Now,Long-term primary patency is not satisfied and the cost of follow-up and maintenance is high,so patiens and their family members should be informed in detail before AVG.