【摘要】目的分析以超声引导腔内球囊碎栓的方式治疗自体动静脉内瘘(autologous arteriovenous fistula，AVF)和人工血管动静脉内瘘(arteriovenous graft，AVG)血栓闭塞病变，旨在探讨该方法对于内瘘血栓闭塞的治疗效果。方法回顾分析2018 年01 月～2019 年12 月在南京医科大学第二附属医院血液净化中心因内瘘狭窄导致血栓闭塞，并首次行超声引导介入碎栓治疗的患者，其中AVF 139 例，AVG 76 例，分析其临床特征，治疗和随访情况，并与因内瘘单纯狭窄介入治疗的数据进行比较。结果139 例AVF 患者均取得即时开通，76 例AVG 患者中，74例取得即时开通；内瘘血栓闭塞首次介入碎栓开通与内瘘狭窄首次介入治疗，两者随访12个月通畅情况没有显著差异(再干预例数比较，AVF χ2/P=0.235/0.651，AVG χ2/P=0.013/0.946；再次干预时间比较，AVFt/P=0.612/0.485，AVG t/P=0.759/0.697)。结论超声引导腔内球囊碎栓处置内瘘血栓闭塞，操作简单、创伤小、安全，具有非常高的即时开通率，并且
对病变治疗彻底，维护了内瘘的完整性，延长其使用寿命。
【Abstract】Objective To explore the therapeutic effect of ultrasound-guided intraluminal balloon intervention to treat thrombo-occlusive disease in autologous arteriovenous fistula (AVF) and artificial arteriovenous graft (AVG). Methods This was a retrospective study. Ultrasound-guided intraluminal intervention was used to treat thrombotic occlusion due to fistula stenosis in 139 cases with AVF and 76 cases with AVG for the first time at the Blood Purification Center, the Second Affiliated Hospital of Nanjing Medical University during January 2018 to December 2019. Their clinical characteristics, treatment and follow- up data were analyzed and compared with those of interventional therapy for simple fistula stenosis in this blood purification center. Results Immediate opening of the fistulas after the treatment was acquired in all 139 cases with AVF and in 74 of the 76 cases with AVG. There was no difference in patency rate after the treatment for 12 months between the first ultrasound-guided intraluminal balloon interventional therapy for fistula thrombosis occlusion and the first interventional therapy for simple fistula stenosis (For re-intervention cases, AVF: χ2=0.235, P=0.651; AVG: χ2=0.013, P=0.946. For time required for re- intervention, AVF: t=0.612, P=0.485; AVG: t=0.759, P=0.697). Conclusion Breaking up the thrombosis in occluded fistulas by using ultrasound-guided intraluminal balloon intervention has the advantages of simple manipulation, minimal invasiveness, safety and a higher immediate patency rate. This method can completely remove pathological causes, maintain integrity and prolong lifespan of the internal fistulas.
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