自体内瘘瘤样扩张缩窄术临床疗效观察

Observation of clinical curative effect of constriction for tumor-like dilatation of autogenous internal arteriovenous fistula

目的观察自体动静脉内瘘瘤样扩张缩窄术的临床疗效。方法选择2016年1月至2017年10月因自体动静脉内瘘瘤样扩张就诊于海南省人民医院血液净化中心的患者,回顾性分析患者临床特点、手术方法、成功率、手术治疗的适应症,术后随访及内瘘使用情况。结果28例患者,男性16例,女性12例,平均年龄(47.0±12.2)岁,平均透析龄(73.8±33.7)月,自体动静脉内瘘自建立至发展为瘤样扩张时间为(51±22)个月。其中23例,术中采用导尿管作为支撑对瘤样扩张行缩窄手术,3例行瘤样扩张切除+近心端重建,2例行结扎内瘘+对侧重建术。手术成功率100%。术后随访6~12个月,临床症状改善明显,内瘘直径由术前的(3.22±0.77)cm缩小至(1.49±0.26)cm,差异具有统计学意义(t=13.686,P<0.01);肱动脉血流量由术前的(2.9±0.9)L/min下降至术后(1.3±0.4)L/min,差异具有统计学意义(t=13.372,P<0.01)。术后1~14d重新使用内瘘透析。结论缩窄术治疗自体动静脉内瘘瘤样扩张效果显著。

Objective To observe the clinical effect of the constriction for tumor-like dilatation of internal arteriovenous fistula.Methods From January,2016 to October,2017,The patients hospitalized in Center for Blood Purification of Hainan Province People’s Hospital from January,2016 to October,2017 were selected to conduct retrospective analysis on clinical features,surgery method,success rate,indications of surgical treatment,postoperative follow-up and internal fistula usein these patients.Results In 28 patients,with 16 males and 12 females,their average age was 47.0±12.2 years old,the average dialysis age was 73.8±33.7 months,and the time period from the construction of internal autogenous arteriovenous fistula development of tumor-like dilatation time was 51±22 months.In 23 cases,the catheter was used as the support to narrow the tumor like dilatation;in 3 cases,removal of tumor-like dilatation and proximal reconstruction were performed;and in 2 cases,ligation of arteriovenous fistula and opposite reconstructed were performed.The operation success rate was 100%.During postoperative follow-up of 6 ~ 12 months,clinical symptoms improved obviously,and the diameter of the arteriovenous fistula was reduced from (3.22±0.77)cm before operation to 1.49 ± 0.26 cm after operation,with difference of statistical significance ( t =13.686,P < 0.01).The blood flow rate in the brachial artery was decreased from the preoperative 2.9±0.9 L/min to the postoperative 1.3± 0.4 L/min,and the difference was statistically significant( t =13.372,P < 0.01).The arteriovenous fistula was re-used 1 ~ 14 days after operation.Conclusions The effect of constriction for the treatment of arteriovenous fistula is significant.