采用单条大隐静脉行腹主动脉-双侧肾动脉旁路术治疗大动脉炎性肾动脉狭窄

目的:研究采用单条大隐静脉行腹主动脉-双侧肾动脉旁路术治疗大动脉炎性双侧肾动脉狭窄的疗效。方法:回顾性分析采用该术式治疗的11例大动脉炎性双侧肾动脉狭窄的连续临床资料。结果:所有病人术前均表现为难控性高血压,1例需依赖血透生存。11例均顺利完成手术,22条肾动脉即刻复通,无围手术期死亡。平均随访时间为45个月。末次随访时平均血压由术前的195/109 mm Hg降至132/83 mm Hg(P50%的再狭窄。结论:该术式是治疗双侧大动脉炎性肾动脉狭窄之安全、有效的方法;可有效降压和改善肾功能;中远期通畅率高。     

肾动脉狭窄80例外科治疗

目的 探讨肾动脉狭窄外科治疗方法的选择和疗效.方法 回顾性分析1997年11月到2008年8月80例肾动脉狭窄患者的外科治疗经验.男性53例,女性27例,年龄9～80岁.病变包括动脉硬化42例,大动脉炎23例,肌纤维发育不良11例.共接受外科治疗83人次,其中腹主动脉肾动脉旁路术13例,自体肾移植术5例,肾切除术1例,肾动脉内膜切除术1例,肾动脉狭窄段切除吻合术1例,球囊扩张术14例,支架成形术48例.结果 围手术期死亡1例.63例获得随访,随访时间1～129个月,2例死亡.随访患者血压(135.7±15.8)/(80.1±8.5)mm Hg(1 mm Hg=0.133kPa),较术前(149.8±18.3)/(88±13.6)mm Hg下降(P<0.01).总的降压有效率为65.6%,动脉硬化、大动脉炎、肌纤维发育不良患者的降压有效率分别为50%、73.3%和100%(P<0.05).随访患者肌酐(112.7±53.6)/μmol/L,低于术前(131.7±91.7)μmol/L(P<0.05).结论 肾动脉狭窄通过外科治疗可以有效改善血压和肾功能,动脉硬化病变首选支架成形,肌纤维发育不良性病变首选球囊扩张,大动脉炎性病变首选手术治疗.     

大动脉炎致肾动脉上腹主动脉闭塞的手术治疗

目的 探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法.方法 回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习.结果 术后患者头痛明显好转,血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19.术后2周复查CTA示人工血管通畅,术后3个月复查彩超示人工血管通畅,血压在(140～150)/(80～95) mm Hg间波动,双眼视力1.0左右,已恢复正常生活.结论 大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血,病变复杂,手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果.     

经皮血管成形术治疗肌纤维发育不良型肾动脉狭窄的临床疗效

目的评价经皮血管腔内血管成形术(PTA)治疗肾动脉肌纤维性发育不良的疗效及安全性。方法选择肌纤维发育不良型肾动脉狭窄患者32例(均合并2~3级高血压或难治性高血压),行经皮肾动脉成形术治疗。术后随访观察患者血压、药物治疗种类、术后再狭窄、生存率和并发症等。结果 PTA技术成功率93.94%(31/33)。术前、术后收缩压分别为(189.6±26.0)mmHg、(136.6±8.0)mmHg(t=9.117,P0.001),舒张压分别为(121.6±21.7)mmHg、(81.1±11.5)mmHg(t=7.745,P0.001)。无肾动脉破裂、夹层、分支堵塞及血栓形成等相关并发症和术后不良事件发生。术后随访时间5~100个月,平均(40.4±26.1)个月,患者生存率100%(32/32)。结论经皮血管成形术治疗肌纤维发育不良肾动脉狭窄安全、有效。     

升主动脉-腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎

目的：为了有效治疗累及胸腹主动脉的Ⅱ、Ⅲ型大动脉炎，探讨升主动脉－腹主动脉旁路移植术的手术疗效。方法：自1976年至2001年采用升主动脉－腹主动脉旁路移植术治疗Ⅱ、Ⅲ型大动脉炎47例，同期行人工血管与肾动脉旁路移植术10例，冠状动脉旁路移植术和自体肾移植术各2例，三尖瓣成形术和髂动脉旁路移植术各1例。结果：术后1例死于凝血障碍出血，死亡率为2．13％；术后因肠梗阻再1列；存活患者血压和血运均明显改善，上肢血压较术前明显下降，平均为118／77mmHg(1kPa=7.5mmHg)vs 177/83mmHg；术后上、下肢血压差别无显著性意义。平均随访8．2年，远期死亡2例（4．35％），再手术1例，远期效果优良率为81．82％。结论：升主动脉－腹主动脉旁路移植术是治疗Ⅱ、Ⅲ型大动脉炎的简单、安全、远期疗效好的方法。     

冠状动脉旁路移植术后静脉移植物内膜增生的治疗进展

大隐静脉是冠状动脉旁路移植术(CABG)中最早使用的旁路血管,目前仍广泛应用于临床.有文献报道,大隐静脉旁路术后1年的通畅率为84％,10年为61％;而乳内动脉的10年通畅率为85％[1].急性旁路血管衰败主要受技术和血栓形成影响,而晚期的衰败(CABG术后1个月以上)则是内膜增生和随之加速的动脉粥样硬化发展所致.现就静脉移植物内膜增生的发病机制及治疗方法作一综述,为临床提供帮助.     

复合血管与倒置大隐静脉旁路移植治疗严重慢性下肢缺血的对比研究

目的比较复合血管序贯式下肢动脉旁路术和倒置自体大隐静脉旁路术治疗严重慢性下肢缺血的效果。方法回顾性分析采用复合式血管(25例)及倒置自体大隐静脉(16例)旁路移植术治疗的41例严重慢性下肢缺血患者的临床资料。复合血管用聚四氟乙烯(PTFE)人工血管及自体静脉组合而成。人工血管近心端与股总动脉吻合,远端与孤立腘动脉吻合;自体静脉从PTFE血管远端发出并与小腿的胫或腓动脉吻合。倒置自体大隐静脉旁路术采用同侧大隐静脉作为血管桥。比较两者血管桥的累积通畅率和保肢率。结果平均随访18.7个月。男29例,女12例。平均年龄(67±10.4)岁。FontaineⅢ级23例,FontaineⅣ级18例。复合血管组中自体静脉远端吻合口止于胫前动脉5例,胫后动脉14例,腓动脉6例;倒置大隐静脉移植组中10例吻合口止于胫后动脉,3例腓动脉,3例胫前动脉。复合血管组踝肱指数术前为0.24±0.14,术后为0.68±0.22(P=0.000)。倒置大隐静脉组平均踝肱指数术前为0.24±0.14,术后为0.68±0.22(P=0.000)。复合血管术后1,2,3年首次通畅率分别为78%,72%,61%;二期通畅率分别为83%,76%,6...     

移植肾动脉狭窄腔内治疗的中期结果

目的探讨移植肾动脉狭窄经皮血管腔内成形(PTA)及支架置入的安全性及中远期结果。方法回顾性分析2011年1月至2018年12月解放军总医院血管外科收治的18例移植肾动脉狭窄患者的临床资料。结果3例经同侧股动脉,15例经对侧股动脉人路治疗。4例单纯PTA治疗,8例PTA后置入支架,6例直接置入支架。共置入14枚支架,均为球扩式支架,其中2枚为药涂支架,技术成功率100%。平均造影剂用量64ml,治疗前肾动脉狭窄率为50%〜99%,腔内治疗后狭窄率降为10%〜30%。收缩压由术前的(157.2±43.0)mmHg降至术后的(129.8±8.6)mmHg;血清肌酐(SCr)水平由术前的(258.8±214.7)μmol/L降至术后的(176.3±101.1)μmol/L,尿素氮由术前的(15.7±1.6)mmol/L降至术后(10.6±1.1)mmol/L(均P<0.05)。术后中位随访42.4个月(3~93个月),治愈17例,无效1例,1例单纯球囊扩张后术后30 d出现再狭窄,予以置入支架。除1例移植肾动脉出血外无其他并发症。结论移植肾动脉狭窄是导致移植肾失功的常见血管因素,腔内治疗安全、有效。     

肾动脉狭窄的腔内治疗经验

目的探讨腔内治疗肾动脉狭窄的临床疗效及影响因素。方法2003年2月至2005年6月共收治19例肾动脉狭窄患者,分析其中行腔内治疗12例的临床资料。其中动脉硬化9例,多发性大动脉炎1例,纤维肌性发育不良2例。结果本组12例,均有严重高血压,1例肾功能异常。支架置入10例,技术成功率91．7％(11／12)。随访12例,随访时间3—15个月,随访平均6．5个月,患者血压从(172±26／98±15)降至(156±22／88±14)mmHg。高血压治愈2例,改善6例,未愈4例,高血压控制率为66．7％。术后肾功能无明显变化。无并发症和死亡病例。再狭窄1例,再狭窄率为8．3％。结论严格掌握手术适应证,腔内治疗肾动脉狭窄是安全、有效的。     

经皮腔内肾动脉支架成形术治疗动脉粥样硬化性肾动脉狭窄的疗效分析

目的探讨经皮腔内肾动脉支架成形术(percutaneous transluminal renal artery stenting,PTRAS)治疗动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)的疗效。方法回顾分析2002年1月-2008年12月,采用PTRAS治疗69例ARAS患者的临床资料。男47例,女22例;年龄42～88岁,平均66.2岁。单侧66例,其中1例为单功能肾;双侧3例。肾动脉造影显示肾动脉狭窄程度为70%～99%。合并高血压67例,外周血管病损69例,冠心病34例,糖尿病44例,高血脂症36例。观察患者术后肾功能及血压变化并分析疗效。结果 1例肾动脉狭窄程度为99%的患者因急性夹层导致急性肾动脉闭塞,改行急诊旁路移植术;余68例均成功植入肾动脉支架,成功率为98.6%。68例肾动脉支架成功植入者中,1例术后3个月失访,1例术后6个月死于心肌梗死;余66例获随访,随访时间13～60个月,平均32个月。随访12个月时,血清肌酐水平为(107.8±35.4)μmol/L,与术前(104.1±33.8)μmol/L比较差异无统计学意义(P0.05);9例肾功能改善(13.6%),48例稳定(72.8%),9例恶化(13.6%),肾功能获益率为86.4%。64例术前高血压患者随访12个月时,收缩压自术前(163±34)mm Hg(1mm Hg=0.133kPa)降至(132±24)mm Hg,舒张压自术前(89±17)mm Hg降至(78±11)mm Hg,差异均有统计学意义(P0.05);4例高血压治愈(6.3%),52例改善(81.2%),8例失败(12.5%),高血压获益率为87.5%。随访12个月时2例(3.0%)出现再狭窄。结论 PTRAS治疗ARAS的手术成功率高,有助于高血压患者血压控制和稳定肾功能,远期疗效需进一步随访观察。     

Renal revascularization in Takayasu arteritis-induced renal artery stenosis

PURPOSE: This study was undertaken to define the long-term effects of renal revascularization on blood pressure, and renal and cardiac function in patients with Takayasu arteritis-induced renal artery stenosis (TARAS). METHODS: Twenty-seven patients (25 women; mean age, 27 years) with TARAS underwent intervention. Primary, primary assisted, and secondary patency rates were determined, and the late effects on blood pressure, renal and cardiac function, and survival were analyzed. RESULTS: All patients had hypertension (mean blood pressure, 167/99 mm Hg; 2.5 antihypertensive medications per patient). Mean estimated glomerular filtration rate in patients not receiving hemodialysis was 76 mL/min, and in five patients serum creatinine concentration was greater than 1.5 mg/dL. Three patients were hemodialysis-dependent, and two had intractable congestive heart failure. Forty interventions were performed, including 32 aortorenal bypass procedures, two repeat implantations, four nephrectomies, and two transluminal angioplasty procedures. Postoperative morbidity was 19%. There were no deaths. During follow-up (mean, 68 months), three graft stenoses, all due to intimal hyperplasia, and three graft occlusions occurred. Two of three graft stenoses were successfully revised. At 1, 3, and 5 years of follow-up, primary patency was 87%, 79%, and 79%, respectively; primary assisted patency was 93%, 89%, 89%, respectively; and secondary patency was 93%, 89%, and 89%, respectively. Intervention resulted in a decrease in blood pressure to a mean of 132/79 mm Hg (P<.0001), and the need for antihypertensive medications was reduced to one per patient (P<.01). Mean glomerular filtration rate increased to 88 mL/min (P<.005), and two patients no longer required hemodialysis. Congestive heart failure resolved in both patients, and did not recur. There were three deaths during follow-up, with 5-year and 10-year actuarial survival of 96% and 80%, respectively. CONCLUSIONS: Renal revascularization to treat TARAS is durable, has a salutary effect on blood pressure, and enhances long-term renal and cardiac function. This response establishes renal revascularization as a successful and durable intervention for TARAS, and a benchmark to which other therapies should be compared.     

Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation

Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type 1 receptor blockers (ARB) reduce cardiovascular death in the general population, but data for renal transplant recipients remain elusive. Similarly, ACEI/ARB have been shown to reduce proteinuria, but data on graft survival are lacking. Therefore a retrospective open cohort study was conducted of 2031 patients who received their first renal allograft at the Medical University of Vienna between 1990 and 2003 and survived at least 3 mo. Patient and graft survival was compared between patients with versus without ACEI and/or ARB therapy. Data were analyzed with and without propensity score models for ACEI/ARB therapy. Medication and comorbidities were analyzed as time-dependent variables in the Cox regression analyses. Ten-year survival rates were 74% in the ACEI/ARB group but only 53% in the noACEI/ARB group (P<0.001). The hazard ratio (HR) of ACEI/ARB use for mortality was 0.57 (95% confidence interval [CI] 0.40 to 0.81) compared with nonuse. Ten-year actual graft survival rate was 59% in ACEI/ARB patients but only 41% in nonusers (P=0.002). The HR of actual graft failure for ACEI/ARB recipients was 0.55 (95% CI 0.43 to 0.70) compared with nonusers; the HR of functional graft survival was 0.56 (95% CI 0.40 to 0.78). Ten-year unadjusted functional graft survival rates were 76% among ACEI/ARB patients and 71% in noACEI/ARB recipients (P=0.57). In summary, the use of ACEI/ARB therapy was associated with longer patient and graft survival after renal transplantation. More frequent use of these medications may reduce the high incidence of death and renal allograft failure in these patients.     

Long-term results justify autogenous infrainguinal bypass grafting in patients with end-stage renal failure.

INTRODUCTION: Infrainguinal bypass grafting for limb-threatening ischemia in patients with end-stage renal disease is generally thought to be associated with increased operative risk and poor long-term outcome. This retrospective study was undertaken to examine the modern-era, long-term results of infrainguinal bypass grafting in dialysis-dependent patients. METHODS: Over the past 5 years in a single institution, 425 lower extremities (368 consecutive patients) were revascularized for the indication of limb salvage. Sixty-four patients (82 limbs) were dialysis-dependent at the time of revascularization, and this group was analyzed separately. They exhibited statistically significant higher incidences of diabetes (83% vs 56%; P <.001), hypertension (91% vs 74%; P <.001), and more distal vascular disease, which required a greater proportion of proximal anastomoses at the popliteal level (24% vs 11%; P <.01) and distal anastomoses at the infrapopliteal level (75% vs 65%; P <.05). RESULTS: Despite the higher prevalence of comorbid conditions and distal disease in patients with renal failure, their perioperative 30-day mortality rate remained low (4.9%) and was not significantly different from that in patients with functioning kidneys (2.9%; P = not significant). After a median follow-up of 11 months (range, 0-60 months), the 3-year autogenous conduit secondary graft patency in patients with renal failure was no different than in patients with functioning kidneys (67% +/- 9% vs 64% +/- 5%; P = not significant). Nonautogenous conduits in dialysis-dependent patients exhibited a significantly poorer outcome with only 27% +/- 12% remaining secondarily patent at 2 years. As expected, both limb salvage and patient survival were significantly less in patients with renal faiture, although both exceeded 50% at 3 years (limb salvage 59% +/- 8% vs 68% +/- 5%; P <.05; patient survival 60% +/- 8% vs 86% +/- 4%; P <.001). The often-quoted phenomenon of limb loss, despite a patent bypass graft, occurred infrequently in this study (n = 3 of 82 limbs). CONCLUSION: Infrainguinal revascularization can be performed in dialysis-dependent patients with acceptable perioperative and long-term results, especially in patients in whom adequate autologous conduit is available.     

The association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use during postischemic acute transplant failure and renal allograft survival

BACKGROUND: Postischemic acute renal transplant failure occurs in approximately one fourth of all dead donor transplantations. Uncertainty exists regarding the putative association between the use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II AT1 receptor blockers (ARBs) and kidney transplant graft survival in patients with delayed allograft function. METHODS: We conducted an open cohort study of all 436 patients who experienced an acute renal transplant failure out of all 2,031 subjects who received their first kidney transplant at the Medical University of Vienna between 1990 and 2003. Actual and functional graft survival was compared between users and nonusers of ACEI/ARB using exposure propensity score models and time-dependent Cox regression models. RESULTS: Ten-year actual graft survival averaged 44% in the ACEI/ARB group, but only 32% in patients without ACEI/ARB (P=0.002). The hazard ratio of actual graft failure was 0.58 (95% confidence interval: 0.35-0.80, P=0.002) for ACEI/ARB users compared with nonconsumers. Seventy-one percent of subjects with ACEI/ARB had a functional graft at 10 years versus 64% of ACEI/ARB nonusers (P=0.027). The hazard ratio of functional graft loss was 0.48 (95% confidence interval: 0.24-0.91, P=0.025). CONCLUSIONS: Use of ACEI/ARB in patients experiencing delayed allograft function was associated with longer actual and functional transplant survival.     

Early and mid-term results of off-pump coronary artery bypass grafting in patients with end stage renal disease: surgical outcomes after achievement of complete revascularization

End stage renal disease is a risk factor for mortality after coronary artery bypass grafting. We conducted a retrospective review of 37 consecutive dialysis-dependent patients who underwent off-pump coronary artery bypass grafting between April 2001 and July 2004. Complete revascularization was successfully performed in all patients. The mean number of anastomoses was 3.7, and early graft patency was 98.8%. Thirty-day mortality was 2.7%. In-hospital mortality was 8.1%. At a mean follow-up of 26 months, there were six late deaths including one cardiac death, and five cardiac events. Actuarial survival rate at one and three years was 88.8% and 77.0%, respectively. Cardiac event free rate at one and three years was 85.9% and 72.6%, respectively. Multivariate analysis revealed that preoperative left ventricular ejection fraction (P=0.003) and smoking history (P=0.026) were significant predictors for mid-term mortality, and co-existing peripheral vascular disease was a significant predictor for cardiac events (P=0.033). Early and mid-term outcomes after off-pump coronary artery bypass grafting in patients with end stage renal disease have acceptable mortality rate with excellent early graft patency, while low ejection fraction and smoking history were significant risk factors for mid-term survival, and co-existing peripheral vascular disease was a significant predictor for cardiac events.     

Analysis of predictive factors for the decline of residual renal function in new peritoneal dialysis patients

Objective To prospectively evaluate the risk factors for the decline of residual renal function (RRF) in new peritoneal dialysis (PD) patients. Methods A total of 84 new PD patients in our PD center were included in this study. Clinical comprehensive assessment were made, and regression models was established to analyze the relationship between the decline of RRF and clinical indicators, which included the rate of peritonitis, systolic pressure, diastolic pressure, urine volume, 24 h urinary protein, serum albumin, C-reactive protein(CRP), history of diabetes mellitus, and the use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) drugs, cardiac functional grading, sodium and water retention and biochemical indicators. The primary outcome was defined as two consecutive urine volume ≤100 ml/24 h. Results The mean follow-up time was (11.7± 1.1) months, primary outcome occurred in 20 patients, accounting for 23.8%, and their average period progressed to the primary outcome was (10.5±2.0) months. The 20 patients had higher ultrafiltration volume [(551.6±328.2) ml vs（294.1±288.0) ml, P=0.001], higher systolic blood pressure [(145.2±16.5) mmHg vs (136.0±13.8) mmHg, P=0.016], worse cardiac functional grading [(1.7±0.8) vs (1.3±0.4), P=0.000], more serious water-sodium retention [(1.0±0.7) vs (0.6±0.5), P=0.012], higher peritonitis rates (35.0% vs 4.7% ,P=0.000), lower Kt/V [(1.7 ± 0.4) vs (2.0 ± 0.3), P=0.003], lower hemoglobin levels [(89.0±14.9) g/L vs (99.5±17.8) g/L, P=0.020], higher C - reactive protein levels [(19.4±34.4) mg/L vs(8.7±12.6) mg/L, P=0.017], higher Scr levels [(1 004.6±291.1) μmol/L vs (753.1± 254.3) μmol/L, P=0.000], lower serum calcium levels[(1.86±0.1) mmol/L vs (2.02±0.2) mmol/L, P=0.000], higher serum phosphorus [(2.1±0.6) mmol/L vs (1.6±0.4）mmol/L, P=0.001] and higher calcium phosphorus product [(3.8±1.1) mmol2/L2 vs (3.1±0.8) mmol2/L2, P=0.010] as compared with those of the patients without the primary outcome. Based on the results of multivariable Cox regression analysis, ultrafiltration volume, cardiac functional grading, peritonitis, Kt/V and serum phosphorus level contributed to the decline of RRF significantly. Conclusion The higher Kt/V in PD patients plays a protective role, the higher ultrafiltration volume, the worse heart function, the more peritonitis rate and higher serum phosphorus predict more rapid declination of RRF.     

Blood pressure, antihypertensive treatment, and graft survival in kidney transplant patients

Whether the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker inhibitor (ACEI/ARB) is beneficial in renal transplant recipients remains controversial. In this retrospective study on 505 renal transplant recipients, we analyzed blood pressure and graft survival according to antihypertensive treatment with ACE-I/ARB and/or calcium channel blockers (CCB) over a period of 10 years. Patients were stratified according to their blood pressure 1 year after transplantation [controlled (≤130/80 mmHg; CTR, 181 patients) and noncontrolled (>130/80 mmHg; non-CTR, 324 patients)] and according to antihypertensive treatment (ACE-I/ARB and/or CCB taken for at least 2 years). One year after transplantation, 88.4% of CTR and 96.6% of non-CTR received antihypertensive treatment ( P  < 0.05). Graft survival was longer in CTR than in non-CTR ( P  < 0.05). Importantly, graft survival was longer in patients who received long-term treatment with ACEI/ARB, CCB, or a combination of ACEI/ARB and CCB ( P  < 0.001). The beneficial effect of ACEI/ARB therapy was more pronounced in non-CTR compared with that of CTR. We conclude that blood pressure control is a key target for long-term graft survival in renal transplant patients. Long-term ACEI/ARB and CCB therapy is beneficial for graft survival, especially in patients with diabetes and/or albuminuria.     

Clinical application of covered metal stents in treating central venous occlusion of different branches in hemodialysis patients

Objective To evaluate the efficacy of covered stent (CS) in the treatment of central venous occlusive disease (CVOD) of different branches in hemodialysis patients. Methods Twenty-five cases of CVOD in the First Affiliated Hospital of Sun Yat-sen University from Oct 2015 to June 2018 were enrolled. All patients underwent percutaneous transluminal angioplasty (PTA)+stent graft (PTS) successfully. The stent grafts of different diameters were implanted according to intraoperative angiography to measure the diameter of normal blood vessels around the diseased vessels. The operation was successful and the follow-up data was complete. According to the different branches of central venous lesions, the patients were divided into three groups: subclavian vein group, brachiocephalic vein group and superior vena cava group. The stent diameter, primary patency and assisted primary patency time were analyzed and compared in the three groups. Results The diameters of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group were (10.29±0.42) mm, (12.29±0.32) mm and 13.00 mm, respectively. There were significant differences in the diameters of the subclavian vein group, the superior vena cava group and the brachiocephalic vein group (both P＜0.05). As of the end of follow-up, the primary patency time of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group was (10.57±2.00) months, (19.40±3.28) months, and (32.75±3.28) months respectively. The primary patency time of the superior vena cava group was significantly longer than the other two groups (P＜0.05). There was no significant difference in the primary patency time between the subclavian vein group and the brachiocephalic vein group (P=0.072). The assisted primary patency time of the subclavian vein group, the brachiocephalic vein group and the superior vena cava group was (15.57±3.20) months, (25.14±2.39) months, (39.00±3.03) months. There was a statistically significant difference in the assisted primary patency time between the three groups (P＜0.05). Conclusions There are differences in vascular patency between postoperative vascular grafts of different diameters in different sites. The larger the diameter of the lumen stent, the longer the stent patency time is. It is important to protect the blood vessels with smaller diameters.     

长腹膜透析龄患者首次腹膜炎的临床特征分析

目的 探讨长腹膜透析龄患者首次腹膜炎的临床特征。 方法 回顾性分析2000年至2009年发生首次腹膜透析相关性腹膜炎患者315例,按发生首次腹膜炎时腹膜透析龄分为两组：A组（<36个月）261例,B组（≥36个月）54例。对两组相关临床资料进行比较。 结果 入组患者平均年龄（55.7±15.9）岁,男性占61.0%,基础肾脏病主要为慢性肾小球肾炎（54.6%）,其次为糖尿病肾病（20.6%）。发病时A组中位腹膜透析龄8.4个月;B组中位腹膜透析龄49.4个月。发生腹膜炎时,两组间血红蛋白、血清白蛋白和血钾水平差异无统计学意义,但两组血清白蛋白和血钾水平均低于正常值范围。两组腹膜炎最常见诱因均为换液操作接触污染（48.2%比45.2%）。剔除未做透出液细菌培养患者,两组革兰阳性菌分布情况差异无统计学意义,但B组革兰阳性菌对甲氧西林的耐药率显著高于A组（46.2%比19.1%,P = 0.035）。两组革兰阴性菌分布情况及超广谱耐药菌比例差异无统计学意义。B组真菌感染比例显著高于A组（17.8%比6.4%,P = 0.011）。B组初始治疗有效率及临床结局显著差于A组（均P < 0.05）。两组间革兰阴性菌及真菌腹膜炎治疗失败率差异无统计学意义,但B组革兰阳性菌、无菌生长及未作培养腹膜炎治疗失败率显著高于A组（23.1%比1.5%、46.2%比6.7%、22.2%比0%,均P < 0.05）。Logistic回归分析整体资料显示,真菌感染、发病时较长腹膜透析龄、较低血清白蛋白水平为首次腹膜透析相关性腹膜炎治疗失败的独立影响因素（P = 0.000、0.002、0.025）。 结论 长腹膜透析龄患者首次腹膜炎的临床结局较短腹膜透析龄患者差。较高真菌和其他耐药菌感染率以及营养不良是影响其疗效的主要因素。