旁路转流术在失功动静脉内瘘流出道重建中的应用

Application of bypass surgery for reconstruction of outflow tract of dysfunctional internal fistula

目的探索旁路转流术修复流出道长段闭塞动静脉内瘘的临床效果。方法回顾性分析2016年6月~2020年6月兰州大学第二医院诊治的因动静脉内瘘流出道长段闭塞行旁路转流术病例15例。以同期采用经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗的内瘘血管短段病变的病例作为对照,评价转流修复术临床效果。结果使用大隐静脉或人工血管行旁路转流修复长段流出道闭塞的失功动静脉内瘘手术的修复成功率为100%。与PTA组相比,旁路转流组的2年干预率较低(P=0.032),2年动静脉内瘘通畅率较好(P=0.046)。结论旁路转流术修复长段闭塞的失功动静脉内瘘安全、经济、有效,值得应用。

Objective To explore the clinical effect of bypass surgery to repair the long occlusion in the outflow tract of arteriovenous fistula(AVF).Methods A total of 15 cases subjected to bypass surgery to repair the long occlusion in the outflow tract of AVF in our hospital from June 2016 to June 2020 were retrospectively analyzed.Patients with a short occlusion in the outflow tract of AVF and subjected to percutaneous transluminal angioplasty(PTA)in the same period were recruited as the controls.The clinical effects were compared between the two groups.Results The great saphenous vein or artificial vessel was used for the bypass surgery to repair the long occlusion in the outflow tract of AVF.The successful rate of repair was 100%.Compared to the PTA group,the 2-year intervention rate was lower(P=0.032),and the 2-year patency rate was higher(P=0.046)in the bypass surgery group.Conclusion Bypass surgery is a safe,economical and effective method to repair the long occlusion in the outflow of AVF.