目的 评估球囊扩张、导尿管扩张及液压扩张技术在糖尿病肾病血液透析患者小口径静脉动静脉内瘘(arteriovenous fistula,AVF)手术中的效果。方法 收集2020年1月—2023年1月邵阳市中心医院及邵阳市中心医院东院首次行AVF手术且头静脉内径(束臂)＜2.5 mm的糖尿病肾病血液透析患者。根据手术中静脉扩张方式分为球囊扩张组、导尿管扩张组、液压扩张组，评估手术后即刻、1个月、2个月及12个月AVF通畅率、再干预率、头静脉内径及肱动脉血流量。 结果 共纳入97例患者，其中球囊扩张组30例，导尿管扩张组35例，液压扩张组32例。3组患者的手术后即时成功率分别为96.7%、85.7%和84.4%，差异无统计学意义(χ²=2.799，P=0.133)。手术后2个月，球囊扩张组内瘘成熟率为93.3%，高于导尿管扩张组(68.6%，χ²=6.190，P=0.013)和液压扩张组(71.9%，χ²=4.885，P=0.027)。手术后12个月，球囊扩张组再干预率为13.3%，低于导尿管扩张组(40.0%，χ²=5.737，P=0.017)和液压扩张组(37.5%， χ²=4.723，P=0.030)。手术后即刻、1个月及2个月，3组患者头静脉直径差异均具有统计学意义(F=23.994、21.311、17.305，均P＜0.001)，Tukey事后检验显示球囊扩张组在各时间点的头静脉直径均高于导尿管扩张组(q=6.390、3.429、4.152，P=0.001、0.035、0.010)和液压扩张组(q=6.711、4.393、5.184，P=0.001、0.002、0.001)。手术后即刻、1个月及2个月，3组患者肱动脉血流量差异均具有统计学意义(F=16.425、14.002、12.631，均P＜0.001)，Tukey事后检验显示球囊扩张组在各时间点的肱动脉血流量均高于导尿管扩张组(q=4.180、2.551、2.758，P=0.001、0.034、0.020)和液压扩张组(q=5.533、3.357、3.374，P=0.001、0.004、0.003)。 结论 球囊扩张技术在糖尿病肾病血液透析患者的小口径静脉扩张中表现出优势，可提高动静脉内瘘的成熟率，减少再干预率，具有良好临床应用前景。
Objective To evaluate the efficacy of balloon dilation, catheter dilation, and hydraulic dilation techniques for small-caliber veins in arteriovenous fistula (AVF) surgery of diabetic nephropathy patients. Methods This retrospective study enrolled 97 diabetic nephropathy patients for the construction of a new AVF at Shaoyang Central Hospital and its East Branch from January 2020 to January 2023. The preoperative cephalic vein diameters (tourniquet applied) were less than 2.5 mm in all patients. Based on intraoperative vein dilation technique, the patients were divided into three groups: balloon dilation group (n=30, using 3～4 mm×80 mm balloon catheter), catheter dilation group (n=35, using 6F urinary catheter), and hydraulic dilation group (n=32, saline hydraulic dilation). AVF patency rate, re-intervention rate, cephalic vein diameter, and brachial artery blood flow immediately after surgery and after surgery for 1, 2 and 12 months were used to assess their outcomes. Results Immediate success rates in balloon, catheter, and hydraulic groups were 96.7%, 85.7%, and 84.4%, respectively, without significant difference (χ²=2.799, P=0.133). After 2 months, AVF maturation rate was significantly higher in balloon group (93.3%) than in catheter (68.6%, χ²=6.190, P=0.013) and hydraulic groups (71.9%, χ²=4.885, P=0.027). After 12 months, re-intervention rate was lower in the balloon group (13.3%) than in catheter (40.0%, χ²=5.737, P=0.017) and hydraulic groups (37.5%, χ²=4.723, P=0.030). Cephalic vein diameter and brachial artery blood flow showed statistically significant differences among groups immediately after surgery and after surgery for one and two months (Cephalic vein diameter: F=23.994, 21.311 and 17.305 respectively; P＜0.001. Brachial artery blood flow: F=16.425, 14.002 and 12.631 respectively; P＜0.001). Tukey’s post hoc tests revealed that balloon group had significantly greater cephalic vein diameters than catheter (q=6.390, 3.429 and 4.152 respectively; P=0.001, 0.035 and 0.010 respectively) and hydraulic groups (q=6.711, 4.393 and 5.184 respectively; P=0.001, 0.002 and 0.001 respectively), as well as significantly higher brachial artery blood flow than catheter (q=4.180, 2.551 and 2.758 respectively; P=0.001, 0.034 and 0.020 respectively) and hydraulic groups (q=5.533, 3.357 and 3.374 respectively; P=0.001, 0.004 and 0.003 respectively). Conclusion Balloon dilation for small-caliber vein dilation during surgery has the advantages of a higher AVF maturation rate and a lower re-intervention rate in diabetic nephropathy hemodialysis patients, which has a prospect of clinical application.
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