摘要
Abstract
Objective:To explore the clinical efficacy and safety of arteriovenous fistula excision and reconstruction surgery in patients with hemodialysis arteriovenous fistula stenosis.Method:A total of 68 patients with hemodialysis arteriovenous fistula stenosis admitted to the Department of Nephrology of Shangrao People's Hospital from June 2022 to June 2024 were selected and divided into observation group and control group according to the random number table method,with 34 cases in each group.The control group was treated with percutaneous transluminal angioplasty(PTA),while the observation group was treated with arteriovenous fistula excision and reconstruction surgery.The hemodynamic parameters[inner diameter and cross-sectional area of narrowed vessels,resistance index(RI)and blood flow volume(FV)of brachial artery]and quality of life(SF-36)of the two groups before the surgery and at 3 and 6 months after the surgery were compared.The patency of internal fistulas at 3,6 and 12 months after the surgery and the safety at 1 month after the surgery were compared between the two groups.Result:Before the surgery and 3 months after the surgery,there were no statistically significant differences in the inner diameter and cross-sectional area of narrowed vessels,the RI,FV of brachial artery,and the scores of each dimension of the SF-36 between the two groups(P>0.05).At 6 months after the surgery,the inner diameter and cross-sectional area of the narrowed vessels in the observation group were larger than those in the control group,the brachial artery RI was smaller than that in the control group,and the scores of each dimension of SF-36 were higher than those in the control group(P<0.05).At 6 months after the surgery,there was no statistically significant difference in brachial artery FV between the two groups(P>0.05).There were no statistically significant differences in the patency rate of internal fistula at each time point after surgery and the total incidence of adverse events within one month after surgery between the two groups(P>0.05).Conclusion:Both arteriovenous fistula excision and reconstruction surgery and PTA can improve the hemodynamic parameters,quality of life and fistula patency rate of patients with hemodialysis arteriovenous fistula stenosis,and the safety is comparable.However,compared with PTA,arteriovenous fistula excision and reconstruction surgery demonstrated more significant clinical advantages at 6 months after the surgery.For hemodialysis patients who need to rapidly improve vascular access function,internal fistula resection and reconstruction can be considered as a clinical option.关键词
内瘘切除重建术/经皮球囊扩张术/动静脉内瘘狭窄/血液透析/血流动力学Key words
Arteriovenous fistula excision and reconstruction surgery/Percutaneous transluminal angioplasty/Arteriovenous fistula stenosis/Hemodialysis/Hemodynamics
