探讨超声引导下经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)在自体动静脉内瘘(autogenous arteriovenous fistula，AVF)血栓形成治疗中的疗效。 方法 选择浙江省台州医院肾内科2016年1月～2020年11月因AVF血栓形成接受超声引导下PTA治疗(PTA组)或开放性手术治疗(开放性手术组)的患者为研究对象，回顾性分析患者一般情况，手术相关情况及并发症，随访12月，观察第3、6、9、12月初级通畅率、次级通畅率。 结果 该研究共纳入125例AVF血栓形成患者为研究对象，PTA组共46例，开放性手术组共79例，手术前2组间血栓形成时间(t=0.315,P =0.753)、麻醉方式(χ2=2.896,P =0.102)、手术时间(t=0.183,P =0.885)、AVF手术成功率(χ2＜0.001,P =1.000)差异无统计学意义。PTA组治疗费用高于开放性手术组(t=8.660,P＜0.001)。术后随访，PTA组和开放性手术组第3月、6月初级通畅率差异无统计学意义(χ2=2.016、0.352，P=0.156、0.553)；PTA组第9月、12月初级通畅率低于开放性手术组(χ2=5.787、7.224,P =0.016、0.007)；PTA组较开放性手术组手术后12个月次级通畅率无显著性差异(χ2=0.186,P =0.667)。 结论 对AVF血栓形成患者，超声引导下PTA安全有效、创伤小、手术后恢复快、可重复性强，能够延长内瘘使用寿命，保护患者宝贵的血管资源，是治疗AVF血栓形成的一种有效方法。
Objective To investigate the therapeutic effect of ultrasound-guided percutaneous transluminal angioplasty (PTA) for the treatment of thrombosis in autogenous arteriovenous fistula (AVF). Method, Patients having thrombosis in AVF and treated with ultrasound-guided PTA or open surgery in the Nephrology Department of Taizhou Hospital of Zhejiang Province during January 2016 to November 2020 were retrospectively analyzed. They were followed up for 12 months. Their clinical data, operation-related conditions and complications were recorded. The primary patency rates and secondary patency rates after 3, 6, 9 and 12 months were observed. Result A total of 125 patients with thrombosis in AVF were included in this study, in which 46 patients received ultrasound-guided PTA (PTA group) and 79 patients underwent thrombectomy (surgery group). There were no significant differences in preoperative thrombosis time (t=0.315, P=0.753), anesthesia mode (χ2=2.896, P=0.102), operation time (t=0.183, P=0.885) and success rate (χ2＜0.001, P=1.000) between the two groups. The medical expenses were 14,594.17±4,723.79 yuan in PTA group, significantly higher than that of 6,404.76±5,303.15 yuan in surgery group (t=8.660, P<0.001). There were no significant differences in the primary patency rates after 3 months and 6 months between PTA group and surgery group (after 3 months: 95.65% vs. 91.14%, χ2=2.016, P=0.156; after 6 months: 78.26% vs. 84.81%, χ2=0.352, P=0.553). The primary patency rates after 9 months and 12 months were significantly lower in PTA group than in surgery group (after 9 months: 63.04% vs. 83.54%, χ2=5.787, P=0.016; after 12 months: 58.70% vs. 82.28%, χ2=7.224, P=0.007). The secondary patency rate after 12 months was 97.8% in PTA group and 96.2% in operation group (χ2=0.186, P=0.667). Conclusion In the treatment of patients with thrombosis in AVF, ultrasound-guided PTA is a safe and effective measure, having advantages of prolonged hemodialysis access and saving vascular resources for hemodialysis patients.
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