摘要
目的探讨经皮腔内血管成形术(PTA)治疗血液透析患者自体动静脉内瘘(AVF)失功能的技术成功率及术后通畅率相关影响因素。方法回顾性分析2012年1月至2017年1月采用首次PTA治疗的256例血液透析AVF失功能患者临床资料。其中男147例,女109例,平均年龄(59.3±12.4)岁。评估患者年龄、性别、是否伴有糖尿病、原发疾病、内瘘类型、内瘘位置与狭窄位置、长度、程度等影响因素。结果 256例AVF失功能患者中发现364处狭窄。PTA术技术成功率为96.4%(351/364),临床成功率为97.5%(355/364)。术后早期(6个月内)AVF失功能复发与高龄(P<0.001)、伴有糖尿病(P=0.002)呈正相关。伴有糖尿病(P=0.003)、高龄(P<0.001)与一期通畅率较低显著相关;伴有糖尿病(P=0.021)、高龄(P<0.001)、狭窄段较长(P=0.002)、早期复发(P=0.003)及残余狭窄(P=0.013)与二期通畅率较低显著相关。结论 PTA是一种可替代传统手术治疗AVF失功能的有效方法。术后一期、二期通畅率较低的高龄及伴发糖尿病患者必要时可重复接受PTA术,以保持AVF通畅性。
Objective To investigate the technical success rate of percutaneous transluminal angioplasty（PTA） for de novo dysfunctional arteriovenous fistulas（AVF） in patients receiving hemodialysis,and to discuss the factors that might affect postprocedural fistula patency. Methods The clinical data of a total of 256 hemodialysis patients with dysfunctional AVF, who received initial PTA during the period from January 2012 to January 2017, were retrospectively analyzed. The patients included 147 males and 109 females, with a median age of（59.3 ±12.4） years. The age, sex, coexisting diabetes mellitus, primary disease, the type and location of internal fistula, the length and degree of stenoses, etc. were recorded, and their relationships with the postprocedural fistula patency were analyzed. Results A total of 364 stenoses were detected in 256 patients with de novo dysfunctional AVF. The technical success rate of PTA was 96.4%（351/364）, the clinical success rate of PTA treatment was 97.5%（355/364）. In early post-operative period（within six months）, the recurrence of de novo dysfunctional AVF showed a parallel relationship correlation with the advanced age（P〈0.001） as well as with the presence of diabetes mellitus（P=0.002）. The presence of diabetes mellitus and the advanced age had a significant correlation with the lower primary patency rate（P=0.003 and P〈0.001, respectively）. The lower secondary patency rate bore a close relationship to the presence of diabetes mellitus（P=0.021）, to the advanced age（P〈0.001）, to the length of stenotic segment（P=0.002）,to the early recurrence（P=0.003）, and to the presence of residual stenosis（P=0.013）. Conclusion PTA is an effective method to replace the traditional surgery for the treatment of AVF dysfunction. For elderly patients and diabetic patients, who usually have a lower primary and secondary patency rate, PTA can be repeatedly carried out when necessary so as to keep the patency of AVF.
作者
朱景航
库媛
黄学卿
王黎洲
蒋天鹏
宋杰
周石
ZHU Jinghang;KU Yuan;HUANG Xueqing;WANG Lizhou;JIANG Tianpeng;SONG Jie;ZHOU Shi(Department of Interventional Radiology,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province 550004,China)
出处
《介入放射学杂志》
CSCD
北大核心
2018年第11期1079-1084,共6页
Journal of Interventional Radiology
基金
贵州省普通高等学校医学影像工程研究中心项目(黔教合KY字2016-012)
关键词
经皮腔内血管成形术
血液透析
动静脉内瘘
percutaneous transluminal angioplasty
hemodialysis
arteriovenous fistula
