【摘要】 目的 观察超声引导下经皮球囊扩张术治疗自体动静脉内瘘(AVF)Ⅰ型和Ⅱ型狭窄的临床效果。方法回顾性收集2020年1月至2022年5月南昌大学第一附属医院肾内科收治的AVF狭窄患者156例，其中接受传统外科手术治疗者76例(对照组);超声引导下经皮球囊扩张术治疗者80例(观察组)。比较2组治疗手术成功率，手术导致的临时深静脉置管率，术后3、6、12个月内瘘初级通畅率，手术并发症，治疗效果及随访情况。结果 观察组技术成功77例(96.3%),余3例中2例改为同侧内瘘开放手术，1例改为对侧上肢内瘘重建；对照组技术成功74例(97.4%),余2例术后内瘘闭塞改行留置带隧道和涤纶套的透析导管(tunnel-cuffed catheter, TCC)。2组技术成功率比较差异无统计学意义(P>0.05)。手术成功后患者第1次行血液透析的透析血流量均能满足血液透析需求，无围手术期死亡病例。手术导致的临时深静脉置管率低于对照组(P<0.05)。术后6、12个月时，观察组内瘘初级通畅率低于对照组(P<0.05)。2组术后即刻AVF狭窄处内径、肱动脉通过血流量及第1次行血液透析的透析血流量均高于术前，且观察组高于对照组(P<0.05)。观察组再狭窄或血栓形成发生率为38.8%,高于对照组的18.4%(χ~2=7.847,P<0.05)。结论 超声引导下球囊扩张术治疗AVF管腔Ⅰ型和Ⅱ型狭窄可减轻患者血管损伤，保护血管资源，能扩张内瘘狭窄处内径、提高内瘘自然血流量，该术式相较于传统手术再狭窄率较高，远期通畅率较低，但其创伤小，术后可立即用于血液透析，且手术成功率高、并发症少、临时深静脉置管率低。更多还原

【Abstract】 Objective To observe the clinical efficacy of ultrasound-guided percutaneousballoon dilation in the treatment of type Ⅰ and type Ⅱ stenosis of autologous arteriovenous fistula(AVF).Methods A retrospective analysis was conducted on 156 patients with AVF stenosis admitted to the Department of Nephrology at the First Affiliated Hospital of Nanchang University from January 2020 to May 2022.Among them, 76 patients underwent traditional surgery as the control group, and 80 patients underwent ultrasound-guided percutaneous balloon dilation as the observation group.The surgical success rate and temporary deep vein catheterization rate were recorded; primary fistula patency rate at 3,6 and 12 months after surgery, surgical complications, therapeutic effect and follow-ups were observed and compared between the two groups.ResultsIn the observation group, 77 cases(96.3%) were successfully treated, and 2 of the remaining 3 cases were converted to open surgery for ipsilateral internal fistula, and 1 case was converted to reconstruction of endocardial fistula of the contralateral upper limb; in the control group, 74 cases(97.4%) were successfully treated, and the remaining 2 cases were converted to tunnel-cuffed catheter(TCC) for postoperative endocardial fistula occlusion; there was no statistically significant difference in the success rate between the two groups of techniques(P>0.05).The dialysis blood flow of patients undergoing hemodialysis for the first time after successful surgery could meet the demand for hemodialysis, and there were no perioperative deaths.The rate of temporary deep vein catheteri zation caused by surgery was lower in the observation group than that in the control group(P<0.05).At 6 and 12 months after surgery, the primary patency rate of internal fistula were lower in the observation group than those in the control group(P<0.05).The internal diameter of AVF stenosis, the passing blood flow through the brachial artery, and the dialysis blood flow of the first hemodialysis in the 2 groups were higher than those before surgery in the immediate postoperative period, and they were higher in the observation group than those in the control group(P<0.05).The incidence of restenosis or thrombosis was 38.8% in the observation group, which was higher than that of 18.4% in the control group(χ~2=7.847,P<0.05).ConclusionUltrasound-guided balloon dilation for type I and II stenosis of AVF can reduce patients’ vascular damage, protect vascular resources, expand the inner diameter of the stenosis site, and increase the natural blood flow of the fistula.This surgical method might have a higher rate of restenosis and a lower rate of long-term patency compared with the traditional surgery, but it could be less invasive with minimal trauma and could be immediately used for hemodialysis after surgery, with a high success rate, fewer complications, and a low rate of temporary deep vein catheterization.更多还原