动静脉内瘘重建术与经皮球囊扩张术在老年自体动静脉内瘘狭窄患者中的临床应用

Clinical application of arteriovenous fistula reconstruction and percutaneous transluminal angioplasty in elderly patients with stenosis of autogenous arteriovenous fistula

摘要:

目的 对比研究动静脉内瘘重建术与经皮球囊扩张术(PTA)在自体动静脉内瘘(AVF)狭窄的老年高血压透析患者中的临床应用。方法 回顾性分析2019年2月至2020年2月于内蒙古自治区人民医院血管外科因需进行血液透析治疗而实施AVF手术、术后发生AVF狭窄的老年高血压肾病23例患者的临床资料,根据手术方式不同分2组。对照组患者10例,行动静脉内瘘重建术；试验组患者13例,行PTA术。对比2组患者的一般资料、手术成功率及术后6个月AVF重建率等指标。采用SPSS 22.0统计软件进行数据分析。组间比较分别采用t检验、Mann-Whitney检验及χ²检验。结果 对照组成功率80.00%(8/10),试验组成功率84.61(11/13),差异无统计学意义(P＞0.05)；试验组与对照组AVF重建率[61.54%(8/13)和40.00%(4/10)]、手术创口长度[(3.10±1.76)和(35.00±11.60)mm]、手术时间[(0.90±0.60)和(1.50±0.40)h]、术中出血量[10(9,11)和30(20,50)ml]、造影剂使用量[(50.00±25.17)和(8.13±3.34)ml]比较,差异均有统计学意义(均P＜0.05)。结论 PTA在治疗老年高血压肾病患者AVF狭窄的疗效不劣于动静脉内瘘重建术,PTA血运重建率更高。

Abstract:

Objective To compare the efficacy of arteriovenous fistula reconstruction and percutaneous transluminal angioplasty (PTA) balloon dilatation in the treatment of stenosis in autologous arteriovenous fistula (AVF) in elderly hemodialysis patients with hypertension. Methods A retrospective analysis was performed on the 23 elderly patients with hypertensive nephropathy who underwent AVF surgery due to hemodialysis treatment and then developed stenosis in the fistula in the Vascular Surgery Department of the People′s Hospital of Inner Mongolia Autonomous Region from February 2019 to February 2020. They were divided into 2 groups, receiving arteriovenous fistula reconstruction (control group, n=10) and PTA (study group, n=13), respectively. The general data, surgical success rate and AVF reconstruction rate in 6 months after operation were compared between the 2 groups. SPSS statistics 22.0 was used for data analysis. Data comparison between two groups was performed using student′s t test, Mann-Whitney test or Chi-square test depending on date type. Results The success rate was 80% (8/10) in the control group and 84.61% (11/13) in the study group, with no statistical difference between the two groups (P>0.05). Significant differences were observed in the reconstruction rate of AVF [61.54% (8/13) vs 40% (4/10)], size of wound [(3.10±1.76) vs (35.00±11.60) mm], operation time [(0.90±0.60) vs (1.50±0.40) h], intraoperative blood loss [10 (9,11) vs 30 (20,50) ml) and amount of contrast agent used [(50.00±25.17) and (8.13±3.34) ml] between the study group and control group (all P<0.05). Conclusion The efficacy of PTA is not inferior to arteriovenous fistula reconstruction in the treatment of AVF stenosis in elderly patients with hypertensive nephropathy, and PTA has higher revascularization rate.