开放手术辅助PTA治疗血透患者上肢动静脉 内瘘I型合并II型狭窄的疗效

  目的  探讨开放手术辅助经皮腔内血管成形术（percutaneous transluminal angioplasty, PTA）治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效。  方法  90例已建立上肢自体动静脉内瘘（autogenous arteriovenous fistulas,AVF）并出现Ⅰ型合并Ⅱ型狭窄接受血透治疗患者，随机分为3组，每组30例，A组:超声引导下PTA，B组:数字减影血管造影（digital subtraction angiography, DSA）引导下PTA，C组:开放手术辅助PTA。比较3组手术成功率、手术前后血管内径、肱动脉血流量、AVF通畅率及术后并发症情况。  结果  C组患者手术成功率分别高于A、B组，并发症分别低于A、B组，差异均有统计学意义（P < 0.05）；术前3组患者的血管内径、肱动脉血流量比较差异无统计学意义（P > 0.05），术后即刻和术后1周C组分别大于A、B 2组，差异有统计学意义（P < 0.05）；C组术后6、12月时的AVF通畅率及稳定性分别高于A、B 2组，差异有统计学意义（P < 0.05）。  结论  开放手术辅助经皮腔内血管成形术治疗血液透析患者上肢动静脉内瘘Ⅰ型合并Ⅱ型狭窄的临床疗效显著，能恢复内瘘功能，保证患者有效透析，且操作简单，创伤小，并发症少，可作为部分病例的首选治疗方案。

Effects of Percutaneous Transluminal Angioplasty Plus Open Operation in Hemodialysis Patients with Type I and II Upper Limb Arteriovenous Fistula Stenosis

  Objective  To discuss the effects of percutaneous transluminal angioplasty （PTA） plus open operation in hemodialysis patients with type I and II upper limb arteriovenous fistula （AVF） stenosis.   Methods  Ninty hemodialysis patients who had type I and II AVF stenosis were randomly divided into three groups, 30 cases in each group, group A received the ultrasound-guided PTA, group B received the DSA （digital subtraction angiography）-guided PTA, group C received the PTA and open operation. The successful operation rate, blood vessel diameter, brachial artery blood flow and postoperative complications were compared.   Results  The successful operation rate in group C was significantly higher than group A and group B （P < 0.05）, and the postoperative complication rate in group C was significantly lower than group A and group B （P < 0.05）. Before surgery, the blood vessel diameter and brachial artery blood flow among groups showed no statistically significant difference （P > 0.05）, after surgery and after one week of surgery, the blood vessel diameter and brachial artery blood flow values in group C were significantly higher than group A and group B （P < 0.05）, after 6m and 12m of surgery, AVF patency rate in group C was significantly higher than group A and group B.   Conclusions  PTA combined with open operation is proven to be effective, which can recover the arteriovenous fistula function, guarantee the effective hemodialysis, and reduce the clinical trauma and complications. The easy method shall be primarily recommended for hemodialysis patients with arteriovenous fistula stenosis.