中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 1027-1031.doi: 10.3969/j.issn.1671-4091.2025.12.013

• 血管通路 • 上一篇    下一篇

术前超声造影结合术中超声引导下经皮腔内血管成形术治疗自体动静脉内瘘狭窄的疗效观察

齐聪聪  高宏宇  郝继伟  刘晶晶  韩非非  王 晔  张国英   

  1. 071000 保定，保定市第二医院1肾内科风湿免疫科 2医学影像科CT室
  • 收稿日期:2025-04-01 修回日期:2025-07-10 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 高宏宇 E-mail:1789025031@qq.com
  • 基金资助:
    保定市科技计划项目(2341ZF219)

Observation on therapeutic effect of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided percutaneous transluminal angioplasty on autologous arteriovenous fistula stenosis

QI Cong-cong, GAO Hong-yu, HAO Ji-wei, LIU Jing-jing, HAN Fei-fei, WANG Ye, ZHANG Guo-ying   

  1. Department of Nephrology, Rheumatology and Immunology, 2Department of Medical Imaging CT section, Baoding Second Hospital, Baoding, Hebei 071000, China
  • Received:2025-04-01 Revised:2025-07-10 Online:2025-12-12 Published:2025-12-12
  • Contact: 071000 保定，保定市第二医院1肾内科风湿免疫科 E-mail:1789025031@qq.com

摘要： 目的 观察术前超声造影结合术中超声引导下经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)治疗自体动静脉内瘘(arteriovenous fistula stenosis，AVF)狭窄的疗效。 方法  回顾性分析2022年8月—2024年1月保定市第二医院收治的AVF狭窄患者，按手术前是否行超声造影分成超声组(超声引导下PTA)和超声造影组(术前超声造影结合术中超声引导下PTA)。将患者按照1：1倾向性评分匹配(propensity score matching，PSM)后比较2组手术效果、超声参数、手术后并发症发生率及再狭窄率。 结果  共纳入98例患者，其中超声组47例，超声造影组51例。匹配后超声组、超声造影组各30例。与超声组相比，超声造影组手术时长更短(t=2.315，P=0.020)，手术一次性成功率更高(χ2=5.192，P=0.023)。手术后超声造影组(t=98.505，P＜0.001)和超声组(t=87.315，P＜0.001)内瘘狭窄程度均低于手术前，手术后超声造影组内瘘狭窄程度较超声组更低(t=3.715，P＜0.001)。手术后超声造影组和超声组狭窄处内径(t=29.061、31.852，均P＜0.001)、肱动脉血流量(t=57.226、52.369，均P＜0.001)均大于手术前。超声造影组手术后6个月肱动脉血流量大于超声组(t=5.623，P＜0.001)。2组患者手术后并发症发生率(χ2=0.417，P=0.519)、再狭窄率(χ2=0.647，P=0.421)比较均无统计学差异。 结论  采用术前超声造影结合术中超声引导下PTA可提高AVF狭窄患者手术疗效，改善狭窄程度，促进内瘘血流量有效恢复。

关键词: 超声造影, 超声引导, 经皮腔内血管成形术, 自体动静脉内瘘狭窄

Abstract: Objective  To observe the efficacy of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided percutaneous transluminal angioplasty (PTA) in treating autologous arteriovenous fistula (AVF) stenosis.  Methods  A retrospective analysis was conducted on the data of 98 patients with AVF stenosis admitted to Baoding Second Hospital from August 2022 to January 2024. They were separated into an ultrasound group (n=47, performing PTA under ultrasound guidance) and an contrast-enhanced ultrasound group (n=51, performing preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound guided PTA). After 1:1 propensity score matching (PSM), 30 cases in the ultrasound group and 30 cases in the contrast-enhanced ultrasound group were included in the study. Surgical outcomes, ultrasound parameters, postoperative complications, and restenosis rate were compared between the two groups.  Results  Compared with the ultrasound group, the contrast-enhanced ultrasound group had a shorter surgical duration (t=2.315, P=0.020) and a higher one-time success rate (χ2=5.192, P=0.023). After surgery, the degree of internal fistula stenosis was lower than before surgery in both groups (t=98.505 and 87.315, P<0.001), the degree of internal fistula stenosis in the contrast-enhanced ultrasound group was lower than that in the ultrasound group (t=3.715, P<0.001). After surgery, the inner diameter of stenosis site and brachial artery blood flow were higher than those before surgery in both groups (t=29.061, 31.852; 57.226 and 52.369 respectively; P<0.001), and the two indices in the contrast-enhanced ultrasound group were higher than those in the ultrasound group (t=2.481, P=0.016; t=3.698, P<0.001). After the operation for 6 months, the brachial artery blood flow in the contrast-enhanced ultrasound group was greater than that in the ultrasound group (t=5.623, P<0.001). There were no significant differences in the incidence of postoperative complications and restenosis between the two groups (χ2=0.417, P=0.519; χ2=0.647, P=0.421).  Conclusion  The use of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided PTA can better improve the surgical efficacy of AVF stenosis, the degree of stenosis,  and the blood flow in AVF.

Key words: Contrast enhanced ultrasound, Ultrasound guidance, Percutaneous transluminal angioplasty, Autologous arteriovenous fistula stenosis

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