CT静脉造影联合超声对动静脉内瘘的术前评估价值分析

Application value of CTV combined ultrasonography in preoperative evaluation of arteriovenous fistula

目的探讨CT静脉造影(CTV)联合超声在维持性血液透析患者自体动静脉内瘘术前评估中的价值。方法回顾性分析2017年1月至2019年6月我院106例行动静脉内瘘术的血液透析患者的临床资料,根据术前评估方法的不同将患者分为超声组56例(单纯行超声检查)和CTV组50例(同时行超声及CTV检查)。观察2组患者手术前后超声及CTV影像表现,对比分析CTV组内2种检查方法术前筛选的差异,比较2组间手术一次性成功率、术后1个月内瘘成熟率及术后并发症发生率的差异。结果CTV组内2种检查方法对近心端深静脉狭窄检出率的差异有统计学意义(P<0.05)。CTV组检出率明显高于超声组,差异有统计学意义(P<0.05);CTV组与超声组手术一次性成功率比较差异无统计学意义(P>0.05);术后1个月,CTV组与超声组内瘘成熟率比较差异无统计学意义(P>0.05);CTV组术后并发症发生率低于超声组,差异具有统计学意义(P<0.05)。结论超声联合CTV检查能够对拟行自体动静脉内瘘术的血液透析患者做出良好的术前评估,可有效降低患者术后并发症的发生率。

Objective To evaluate the value of computed tomography venography(CTV)combined with ultrasonography in the preoperative evaluation of autologous arteriovenous fistula in patients with maintenance hemodialysis.Methods A retrospective analysis was performed on 106 hemodialysis patients in our hospital from January 2017 to June 2019 who underwent arteriovenous fistula surgery.According to the preoperative assessment methods,the patients were divided into the ultrasonography group(56 cases examined by ultrasonography)and the CTV group(50 cases examined by ultrasonography and CTV simultaneously).The ultrasonography and CTV imaging manifestations of patients in the two groups before and after surgery were observed,and the differences of preoperative screening between CTV and ultrasonography in the CTV group were compared and analyzed.The one-time success rate of the surgery,fistula maturation rate within one month after surgery and the incidence of postoperative complications were analyzed.Results In CTV group,there was significant difference in the detection rate of proximal deep venous stenosis between CTV and ultrasonography(P<0.05).The detection rate in CTV group was higher than that of ultrasonography group,the difference was significant(P<0.05).There was no significant difference in one-time success rate of the surgery between the two groups(P>0.05).And there was no significant difference in fistula maturation rate within one month after surgery between the two groups(P>0.05).The incidence of postoperative complications in the CTV group(4.0%)was lower than that in the ultrasonography group(28.6%),and the difference was statistically significant(P<0.05).Conclusion Ultrasonography combined with CTV can be used in preoperative evaluation for hemodialysis patients who are planning to undergo autologous arteriovenous internal fistula and can effectively reduce the incidence of postoperative complications.