经皮吸栓与开放取栓治疗人工血管动静脉内瘘急性血栓形成的比较研究

Comparison of percutaneous aspiration thrombectomy and open thrombectomy in treatment of acute thrombosed arterio-venous graft

目的比较经皮吸栓与开放取栓治疗人工血管动静脉内瘘(AVG)急性血栓形成的效果。方法回顾性分析山西医科大学第二医院2014年1月至2019年12月35例行AVG的肾衰患者的临床资料,治疗期间共记录AVG急性血栓事件68例次。根据对AVG急性血栓处理方式的不同将其分为经皮吸栓组(30例次)和开放取栓组(38例次)。比较两组手术情况、手术成功率、并发症、初级通畅率等。组间比较采用t检验和χ2检验。通畅率采用生存曲线分析。结果经皮吸栓组较开放取栓组手术花费少[(15601±1052)元比(21058±2274)元,t=13.719,P=0.038],手术时间短[(1.5±0.5)h比(2.5±0.5)h,t=8.011,P=0.012],手术并发症发生率低(10.0%比52.6%,P=0.013)。两组都未发生症状性肺栓塞。经皮吸栓组和开放取栓组手术成功率比较差异无统计学意义(93.3%与94.7%,χ^(2)=0.059,P=0.532)。开放取栓组3、6、9、12个月初级通畅率分别为100%(38/38)、86.8%(33/38)、71.1%(27/38)、63.2%(24/38),经皮吸栓组分别为100%(30/30)、83.3%(20/30)、66.7%(25/30)、56.7%(17/30),两组比较差异无统计学意义(P=0.581)。结论治疗AVG急性血栓形成时,经皮吸栓与开放取栓的手术成功率和初级通畅率方面相当,在手术花费、手术时间和手术并发症方面经皮吸栓更具优势。

Objective To compare the efficacy of percutaneous aspiration thrombectomy(PAT)and open thrombectomy in treatment of acute thrombosed arterio-venous graft(AVG).Methods From January 2014 to December 2019,68 acute thrombotic events of AVG occurred in 35 patients with renal failure who had underwent AVG in the second hospital of Shanxi Medical University.These acute thrombotic events were divided into PAT group(30 events)and open thrombectomy group(38 events).The operative conditions,success rate,complications and primary patency rate were compared between the two groups.T test and chi-square test were used for comparison.Survival curve was performed to analyze the primary patency rate.Results Compared with the open thrombectomy group,the operation cost[(21058±2274)yuan vs.(15601±1052)yuan,t=13.719,P=0.038]and operation time[(2.5±0.5)h vs.(1.5±0.5)h,t=8.011,P=0.012]of the PAT group was less,and difference showed statistical significance between the two groups.The PAT group had fewer surgical complications than the open thrombectomy group(10.0%vs.52.6%,P=0.013),and no symptomatic pulmonary embolism occurred in both groups.There was no statistical significance in success rate(93.3%vs.94.7%,χ^(2)=0.059,P=0.532)and in primary patency rate between the PAT group and the open thrombectomy group at 3,6,9 and 12 months(100%,83.3%,66.7%,56.7%vs.100%,86.8%,71.1%,63.2%,P=0.581).Conclusion In the treatment of acute thrombosed AVG,PAT has the same success rate and primary patency rate as that of open thrombectomy,and has less operation cost,operation time and surgical complications.