经皮腔内血管成形术治疗人工血管移植物内瘘狭窄或闭塞的疗效
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刘正军, Email: lzj13802755609@163.com;万恒, Email: wanheng1212@163.com

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南方医科大学临床研究启动计划培育基金资助项目(LC2016PY009)。


Efficacy of percutaneous transluminal angioplasty in treatment of stenosis or occlusion of the arteriovenous graft 
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    摘要:

    目的:探讨经皮腔内血管成形术(PTA)对人工血管移植物内瘘(AVG)术后狭窄和闭塞的疗效。
    方法:回顾性分析2016年1月—2018年3月66例AVG狭窄或闭塞行PTA患者的临床资料。
    结果:66例患者共进行105次PTA,技术成功率为96.2%。全组PTA术后的AVG初级通畅时间为(12.1±1.20)个月,其中狭窄病变患者为(16.3±1.95)个月,闭塞病变患者为(10.3±1.36)个月,差异有统计学意义(χ2=4.335,P=0.037);全组PTA术后的AVG累计通畅时间为(19.7±1.46)个月,其中狭窄病变患者为(21.0±2.45)个月,闭塞病变患者为(19.0±1.80)个月,差异无统计学意义(χ2=0.392,P=0.531)。全组术后AVG的6个月、1年的初级通畅率为62.7%、38.8%,其中狭窄病变患者为78.1%、48.9%,闭塞病变患者为53.5%、33.1%;全组术后AVG的6个月、1年的累计通畅率分別为80.9%、74.1%,其中狭窄病变患者为86.9%、79.6%,闭塞病变患者为77.8%、71.4%。
    结论:PTA治疗AVG狭窄或闭塞创伤小、安全有效,患者体验好,具有较好的干预后通畅率;AVG狭窄病变PTA治疗后再狭窄的发生率较高,因此需要进行规律随访监测;狭窄性病变若达到再次干预指征需及时处理,尽量避免瘘管闭塞的发生。对于PTA术中出现血管显著弹性回缩或发生血管破裂出血球囊压迫无法止血的情况,可采用覆膜支架植入进行处理。

    Abstract:

    Objective: To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in treatment of stenosis and occlusion of the arteriovenous graft (AVG).
    Methods: The clinical data of 66 patients undergoing PTA for AVG stenosis or occlusion from January 2016 to March 2018 were retrospectively analyzed.
    Results: A total of 105 times of PTA were performed in the 66 patients, with a technical success rate of 96.2%. The primary patency time of AVG after PTA was (12.1±1.20) months in the whole group of patients, which in patients with stenotic lesion was (16.3±1.95) months and in patients with occlusive lesion was (10.3±1.36) months, and the difference had statistical significance (χ2=4.335, P=0.037). The cumulative patency time of AVG in whole group of patients after PTA was (19.7±1.46) months, which in patients with stenotic lesion was (21.0±2.45) months and in patients with occlusive lesion was (19.0±1.80) months, and the difference had no statistical significance (χ2=0.392, P=0.531). The 6-month and 1-year primary patency rate of AVG in whole group of patients was 62.7% and 38.8%, which in patients with stenotic lesion was 78.1% and 48.9%, and in patients with occlusive lesion was 53.5% and 33.1%, respectively. The 6-month and 1-year cumulative patency rate of AVG in whole group of patients was 80.9% and 74.1%, which in patients with stenotic lesion was 86.9% and 79.6%, and in patients with occlusive lesion was 77.8% and 71.4%, respectively. 
    Conclusion: For AVG stenosis or occlusion, PTA treatment has the advantages of lesser trauma, being safe and effective, and good patients’ experience and high post-intervention patency rate. Stenotic lesions have a higher incidence of restenosis after PTA, so regular follow-up examinations are needed. If the stenotic lesion meets the indication for re-intervention, treatment should be taken in time to avoid fistula occlusion. In cases with significant elastic retraction or rupture of the vessels which cannot be stopped by balloon compression during PTA surgery, the covered stent implantation can be used as a treatment.

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彭嘉欣, 万恒, 刘正军.经皮腔内血管成形术治疗人工血管移植物内瘘狭窄或闭塞的疗效[J].中国普通外科杂志,2019,28(12):1497-1506.
DOI:10.7659/j. issn.1005-6947.2019.12.009

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  • 收稿日期:2019-09-06
  • 最后修改日期:2019-11-19
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  • 在线发布日期: 2019-12-25