CAJ | 학술논문

背景：动静脉内瘘是长期血液透析血管通路的首选，但长期血液透析常发生静脉流出道狭窄，导致血液透析通路闭塞，采用溶栓、介入及手术修复或重新造瘘等解决动静脉内瘘狭窄都有一定的缺点。目的：对比聚四氟乙稀人工血管节段性植入与单纯性手术修复挽救发生流出道狭窄动静脉内瘘的中期效果。方法：选择血管通路静脉段狭窄患者80例，年龄22-80岁，其中试验组50例采用节段性聚四氟乙稀人工血管植入治疗，对照组30例采用单纯手术修复治疗。对比两组术后感染发生率、术后到再次发生内瘘失功时间及累积生存率。结果与结论：试验组随访10-28个月，其中9例患者在随访期间出现血管通路失功，随访6，12，18个月的累积生存率分别为100%，92%，82%；对照组随访8-28个月，其中7例患者在随访期间出现血管通路失功，随访6，12，18个月的累积生存率分别为93%，87%，77%。两组术后感染发生率比较差异无显著性意义。Kaplan-Meier 生存曲线显示试验组患者累积生存率较对照组略高，但 log-rank 检验两组差异无显著性意义(P=0.44)。表明节段性聚四氟乙稀人工血管植入治疗在不破坏原有通路解剖结构、维持原吻合口位置、最大限度保留可穿刺血管资源的基础上，获得了与单纯手术修复相当的临床疗效。
배경：동정맥내루시장기혈액투석혈관통로적수선，단장기혈액투석상발생정맥류출도협착，도치혈액투석통로폐새，채용용전、개입급수술수복혹중신조루등해결동정맥내루협착도유일정적결점。목적：대비취사불을희인공혈관절단성식입여단순성수술수복만구발생류출도협착동정맥내루적중기효과。방법：선택혈관통로정맥단협착환자80례，년령22-80세，기중시험조50례채용절단성취사불을희인공혈관식입치료，대조조30례채용단순수술수복치료。대비량조술후감염발생솔、술후도재차발생내루실공시간급루적생존솔。결과여결론：시험조수방10-28개월，기중9례환자재수방기간출현혈관통로실공，수방6，12，18개월적루적생존솔분별위100%，92%，82%；대조조수방8-28개월，기중7례환자재수방기간출현혈관통로실공，수방6，12，18개월적루적생존솔분별위93%，87%，77%。량조술후감염발생솔비교차이무현저성의의。Kaplan-Meier 생존곡선현시시험조환자루적생존솔교대조조략고，단 log-rank 검험량조차이무현저성의의(P=0.44)。표명절단성취사불을희인공혈관식입치료재불파배원유통로해부결구、유지원문합구위치、최대한도보류가천자혈관자원적기출상，획득료여단순수술수복상당적림상료효。
BACKGROUND:Arteriovenous internal fistula is the first choice for hemodialysis. In the process of hemodialysis, many patients suffer from venous outflow stenosis. The methods including thrombolysis, intervention, surgical repair and fistula reconstruction al have their disadvantages. OBJECTIVE:To compare the midterm effects of polytetrafluoroethylene segment implantation and exclusively surgical repair in arteriovenous internal fistula with outflow tract obstruction. METHODS:Eighty patients with venous outflow stenosis, aged 22-80 years, were divided into test group (n=50;polytetrafluoroethylene segment implantation) and control group (n=30;simple surgical repair). The post-operative infection rate, postoperative time til recurrence of fistula dysfunction, and accumulate survival rate were compared between the two groups. RESULTS AND CONCLUSION:During the fol ow-up period of 10-28 months in the test group, there were nine patients with vascular access dysfunction, and the accumulate survival rate was 100%for 6 postoperative months, 92%for 12 months, and 82%for 18 months. In the control group, there were seven cases of vascular access dysfunction at 8-28 months of fol ow-up, and the accumulate survival rate was 93%for 6 postoperative months, 87%for 12 months, and 77%for 18 months. No statistical y significant difference in the postoperative infection rate was observed between the two groups. The Kaplan-Meier survival curves showed that the accumulate survival rate was slightly higher in the test group than the control group, but there was no significant difference based on log-rank test (P=0.44). These findings indicate that polytetrafluoroethylene segment implantation for arteriovenous internal fistula with outflow tract obstruction has the similar effects as the surgical repair if it does not alter the autologous behavior of the initial access and maximal y reserve the vessels for puncture.