【摘要】目的探讨经皮血管鞘血栓抽吸联合腔内血管成形术(percutaneous transluminal angioplasty, PTA)治疗急性自体动静脉内瘘(arteriovenous fistula,AVF)血栓性闭塞的临床疗效。方法选取西南医科大学附属中医院2014 年3 月～2020 年7 月因AVF 急性血栓性闭塞就诊的患者作为研究对象，回顾性收集患者的临床资料，根据治疗方式分组，即血栓抽吸组(血栓抽吸联合PTA)和局部溶栓组(局部溶栓联合PTA)，比较2 种术式的手术成功率、手术后并发症发生率以及治疗后的1年初级通畅率，通过Kaplan-Meier分析评价通畅率。结果共纳入61例患者，其中血栓抽吸组28例，局部溶栓组33例，血栓抽吸组患者的手术解剖成功率和临床成功率分别为100%、96.4%，高于局部溶栓组96.9%、90.9%，2 组差异无统计学意义(χ2=0.863,P=0.353；χ2=0.753,P=0.385)，血栓抽吸组术后并发症发生率(7.4%)稍高于局部溶栓组(6.7%)，2 组差异无统计学意义(χ2=0.029,P=0.865)；血栓抽吸组患者手术后第3、6、12 个月初级通畅率分别为96.3%、92.6%、74.1%，局部溶栓组分别为96.7%、76.7%、46.7%，2 组一年初级通畅率差异有统计学意义(χ2＝4.158，P=0.041)。结论经皮血管鞘血栓抽吸联合PTA 是治疗急性自体动静脉内瘘血栓性闭塞的安全、有效的方法，可延长内瘘的使用寿命，尤其适用于有溶栓禁忌的患者。
【Abstract】Objective To investigate the efficacy of thrombus aspiration combined with percutaneous transluminal angioplasty (PTA) via percutaneous vascular sheath in the treatment of acute thromboembolism in autologous arteriovenous fistula (AVF). Methods Patients with acute thrombotic occlusion of AVF treated in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from March 2014 to July 2020 were selected as the research subjects. Their clinical data were recruited retrospectively. They were divided into thrombus aspiration group (thrombus aspiration combined with PTA) and local thrombolysis group (local thrombolysis combined with PTA). Surgical success rate, incidence of postoperative complications and primary patency rate after the treatment for one year were compared between the two groups. The patency rate was evaluated by Kaplan-Meier analysis. Results A total of 61 patients were enrolled in this study, including 28 cases in the thrombus aspiration group and 33 cases in the local thrombolysis group. The anatomical success rate and clinical success rate in the thrombus aspiration group were 100% and 96.4% respectively, higher than those of 96.9% and 90.9% respectively in the local thrombolysis group but without statistical significances (χ2=0.863 and 0.753, P=0.353 and 0.385). The incidence of postoperative complications
in the thrombus aspiration group (7.4%) was slightly higher than that in the local thrombolysis group (6.7%) but without statistical significance (χ2=0.029, P=0.865). The primary patency rates after the operation for 3, 6 and 12 months in the thrombus aspiration group were 96.3%, 92.6% and 74.1%, respectively, while those in the local thrombolysis group were 96.7%, 76.7% and 46.7%, respectively; the rates in the two groups were statistically significant (χ2=4.158, P=0.041). Conclusions Thrombus aspiration combined with PTA via percutaneous vascular sheath is a safe and effective method to treat acute thrombotic occlusion of AVF, especially for patients with contraindications of thrombolysis. This method can also prolong the survival time of AVF.
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