内科

目的对比超声引导下球囊扩张联合置管溶栓术与动静脉内瘘重建术治疗动静脉内瘘（AVF）急性血栓闭塞患者的效果。方法选取40例AVF急性血栓闭塞患者作为研究对象，根据治疗方法将其分为球囊组和重建组，每组20例。球囊组行超声引导下球囊扩张联合置管溶栓术，重建组行动静脉内瘘重建术。比较两组临床满意度、有效开通率、并发症发生率、平均住院日和平均住院费用，以及术后1个月、术后3个月和术后6个月的血管有效通畅率。结果球囊组的临床满意度高于重建组，平均住院日短于重建组，平均住院费用高于重建组（均P<0.05）。两组有效开通率差异无统计学意义（P>0.05）。术后1个月和术后3个月，两组血管有效通畅率差异均无统计学意义（均P>0.05）；术后6个月，球囊组血管有效通畅率低于重建组（P<0.05）。结论与动静脉内瘘重建术相比，超声引导下球囊扩张联合置管溶栓术治疗AVF急性血栓闭塞患者临床满意度高，具有创伤小、保存原有吻合口和血管资源的优点，但其血管远期通畅率差，且住院费用高，需结合患者实际情况选择适合的术式。

Objective To compare the effects of ultrasound-guided balloon dilation combined with catheter thrombolysis and arteriovenous fistula reconstruction in the treatment of patients with acute thrombo-occlusion of arteriovenous fistula (AVF). Methods A total of 40 patients with acute thrombo-occlusion of AVF were selected as the study subjects, and they were divided into the balloon group or the reconstruction group according to the treatments, with 20 cases in each group. The balloon group received ultrasound-guided balloon dilation combined with catheter thrombolysis, and the reconstruction group received AVF reconstruction. The clinical satisfaction, effective opening rate, complication incidence, average hospital stay, and average hospitalization cost, as well as the effective vascular patency rates 1 month, 3 months, and 6 months after surgery, were compared between the two groups. Results The balloon group had higher clinical satisfaction, shorter average hospital stay, and higher average hospitalization cost, as compared with the reconstruction group (all P<0.05). There was no statistically significant difference in the effective opening rate between the two groups (P>0.05). The effective vascular patency rate 1 month and 3 months after surgery showed no significant difference between the two groups(all P>0.05); the effective patency vascular rate of the balloon group was lower than that of the reconstruction group 6 months after surgery (P<0.05). Conclusion Compared with AVF reconstruction, ultrasound-guided balloon dilation combined with catheter thrombolysis has higher clinical satisfaction, less trauma, and can preserve the original anastomosis and vascular resources in the treatment of patients with acute thrombo-occlusion of AVF, but its long-term vascular patency rate is poor and the hospitalization cost is high, so it is necessary to choose the appropriate operation according to patients′ actual situations.

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