【摘要】目的研究经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)联合开放手术治疗血液透析患者上肢动静脉内瘘I 合并II 型狭窄的手术效果、长期通畅率及经济效益等。方法选取I 合并II 型狭窄患者40 例，分为A 组PTA 联合开放手术，B 组超声引导下PTA，C组数字减影血管造影(digital subtraction angiography,DSA)引导下PTA。从手术成功率、手术前后血管内径及肱动脉
血流量变化、长期通畅率、手术费用等方面对3 组进行比较分析。结果A组手术成功率优于B组及C 组(X2值分别为8.556, 4.609；P 值分别为0.010、0.052)；A 组术后血管内径大于B组及C组(t 值分别为2.605, 3.676；P 值分别为0.044、0.003)；A组术后肱动脉血流量大于B组及C组(t 值分别为2.764, 2.482；P 值分别为0.030、0.058)；B 组手术费用低于A 组及C 组(t 值分别为3.130，-3.036；P 值分别0.012, 0.015)；log-rank检验提示3 组间术后内瘘生存期比较无统计学差异(P=0.730)。结论PTA联合开放手术治疗I合并II型狭窄在手术成功率、术后血管内径及肱动脉血流量改善有其优势，但在节约血管资源方面比超声引导下PTA及DSA 引导下PTA差，手术费用较超声引导下PTA高。
【Abstract】Objective To investigate the surgical effect, long-term patency rate and economic benefit of PTA combined with open surgery for the treatment of type I combined with type II stenosis in arteriovenous fistulas in upper limbs. Methods A total of 40 patients having type I combined with type II stenosis in arteriovenous fistula were recruited in this study. They were divided into group A (PTA combined with open surgery), group B (ultrasound guided PTA), and group C (DSA guided PTA). Success rate of operation, changes of vessel diameter and blood flow after surgery, long-term patency rate, and medical expenses were compared
among the 3 groups. Results The success rate of operation in group A was better than that in group B and group C (X2=8.556 and 4.609; P=0.010 and 0.052). Post-operative vessel diameter in group A was bigger than that in group B and group C (t=2.605 and 3.676; P=0.044 and 0.003). Post-operative brachial blood flow in group A was greater than that in group B and group C (t=2.764 and 2.482; P=0.030 and 0.058). Medical expenses of group B was lower than that of group A and group C (t=3.130 and -3.036; P=0.012 and 0.015). The long-term patency rate of group A was better than that of group B and group C (P=0.730). Conclusions PTA combined with open surgery to treat type I combined with type II stenosis in arteriovenous fistula has the advantages of higher success rate of operation, greater long-term patency rate, wider post-operative blood vessel diameter and more brachial artery blood flow, but has to use more vascular resources than ultrasound guided PTA and DSA guided PTA. Moreover, patients treated with PTA combined with open surgery have to pay more medical fees than those treated with ultrasound guided PTA.
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