摘要目的 研究超声引导下经皮穿刺腔内血管成形术(percutaneous transluminal angioplasty,PTA)即超声介入治疗后自体动静脉内瘘(AVF)、人工血管内瘘(AVG)各类狭窄病变的通畅率和再狭窄情况.方法 统计在南京医科大学第二附属医院血液净化中心2016年1月至2017年6月因外周血管通路狭窄首次经超声介入成功治疗的患者,其中前臂自体动静脉内瘘71例,上臂自体动静脉内瘘52例,人工血管内瘘59例.多普勒超声综合评估各类通路不同狭窄部位治疗前后数据,随访12个月,观察超声介入治疗3、6、9、12个月的初始通畅率和辅助PTA通畅率,而对于各类通路需要再干预的患者,记录初始通畅时间.结果 超声介入治疗3、6、9、12个月时,前臂AVF的初始通畅率分别为98.59％、90.14％、71.93％、54.93％,上臂AVF的初始通畅率分别为90.38％、65.38％、42.31％、32.69％,AVG的初始通畅率分别为91.53％、32.20％、6.78％、1.69％;前臂AVF的辅助PTA通畅率分别为98.59％、97.18％、95.77％、94.37％,上臂AVF的辅助PTA通畅率分别为92.31％、86.54％、84.62％、80.77％,AVG的辅助PTA通畅率分别为100.00％、98.31％、96.61％、93.22％;前臂AVF的初始通畅时间为(8.99±3.54)个月,上臂AVF的初始通畅时间为(6.33±3.01)个月,AVG的初始通畅时间为(4.80±1.40)个月.结论 超声可以综合评估内瘘外周血管通路的功能,导引PTA治疗,以及评价治疗效果.超声介入治疗前臂AVF狭窄的初始通畅率最好;上臂AVF由于易好发头静脉弓狭窄,PTA治疗预后相对较差;AVG虽然再狭窄间隔时间较短,但通过超声介入定期维护亦可达到较理想的远期通畅率.

abstractsObjective To investigate the patency rate and restenosis after percutaneous transluminal angioplasty (PTA) for the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis in dialysis patients. Methods The patients who were successfully treated by PTA for the first time in the blood purification center of the 2nd Affiliated Hospital of Nanjing Medical University from January 2016 to June 2017, including 71 cases of AVF in the forearm, 52 cases of AVF in the upper arm and 59 cases of AVG were recorded. The data of different stenosis parts were analyzed before and after treatment and followed up for 12 months. The initial patency rate and assisted-PTA patency rate were observed at 3 months, 6 months, 9 months, and 12 months after ultrasound interventional therapy, and the initial patency time for patients who needed to reintervention among all types of pathways were recorded. Results The initial patency rates at 3 months, 6 months, 9 months and 12 months after ultrasound interventional therapy were 98.59％, 90.14％, 71.93％, 54.93％ respectively in forearm AVF, 90.38％, 65.38％, 42.31％, 32.69％ respectively in upper arm AVF, 91.53％, 32.20％, 6.78％, 1.69％ respectively in AVG, and the PTA-assisted patency rates were 98.59％, 97.18％, 95.77％, 94.37％ respectively in forearm AVF, 92.31％, 86.54％, 84.62％, 80.77％respectively in upper arm AVF, 100.00％, 98.31％, 96.61％, 93.22％ respectively in AVG, while the initial patency time was (8.99 ± 3.54) months in forearm AVF, (6.33 ± 3.01) months in upper arm AVF, (4.80 ± 1.40) months in AVG respectively. Conclusions Ultrasound can comprehensively evaluate the function of peripheral vascular access, guide PTA treatment, and evaluate treatment outcomes. Ultrasound intervention therapy has best initial patency rate for forearm AVF stenosis. The prognosis of upper arm AVF stenosis PTA is relatively poor due to the easy cephalic stenosis. Although AVG has a short interval of restenosis, it can achieve a better long-term patency rate through regular intervention with ultrasound intervention.