目的 对药涂球囊(drug-eluting balloon,DEB)和普通球囊(conventional balloon,CB)在自体动静脉内瘘(AVF)腔内血管成形术(PTA)中的应用效果进行Meta分析.方法 检索Cochrane Library、PubMed、EmBase、CNKI、万方等数据库,查找药涂球囊与普通球囊在内瘘PTA中应用效果的文献,对文献进行筛选、提取资料及质量评价.应用RevMan 5.3软件进行统计,对两种方法治疗后随访3个月、6个月和12个月的通畅性进行Meta分析.结果 研究最终纳入8篇文献,其中6篇随机对照试验(randomized controlled trial,RCT),2篇前瞻性队列研究(prospective cohort study,PC),共纳入606例患者.Meta分析结果显示,随访3个月,DEB组相对于CB组改善了内瘘通畅性(OR 0.55,95％CI 0.32-0.93,P=0.03);随访6-12个月,内瘘目标病变通畅性方面,DEB组和CB组总体差异无统计学意义(6个月:OR 0.60,95％CI 0.24-1.45,P=0.25;12个月:R 0.60,95％CI 0.27-1.35,P=0.22).在研究类型的亚组分析中,在PC亚组中显示了DEB的优越性(3个月OR 0.08,95％CI 0.01-0.70,P=0.02;6个月OR 0.10,95％CI 0.02-0.58,P=0.01;12个月OR 0.12,95％CI 0.04-0.36,P=0.0001),而在RCT中没有显示出统计学差异(3个月OR 0.71,95％CI 0.30-1.71,P=0.45;6个月OR 0.93,95％CI 0.39-2.21,P=0.88;12个月OR 0.86,95％CI 0.41-1.82,P=0.70).结论 在介入治疗自体内瘘病变方面,与传统PTA相比,DEB血管成形术在短期内(3个月)显示了较好的通畅性,但中长期结果未显示出明显的优势.严格选择DEB的适应证,有助于提高内瘘PTA术后的通畅性.

Objective To compare the hemodynamic effects of two engaging and traditional end-to-side anastomoses by numerical simulating analysis for internal fistula.Methods Two fistula models of end-to-side anastomosis were developed and appropriate boundary conditions, cloud diagram of fluid velocity, pressure, vorticity and streamline diagram formed respectively.Along the center line of anastomotic lumen, the values of pressure, velocity and vorticity were calculated and displayed in an XY graph correspondingly.Results The results of two models with computational fluid dynamics showed that the pressure and velocity gradient of engaging anastomosis were smaller than traditional anastomosis in cloud diagram and the area of vorticity was less than the latter.In streamline diagram, streamline near engaging anastomosis was smoother and less disordered.And XY graph distinctly indicated that pressure and velocity gradient and vorticity intensity of engaging anastomosis were better than those of traditional anastomosis.Conclusion The geometric conformation of engaging anastomosis influences hemodynamics less and contributes more to maintain the patency of internal fistula.Thus the application of engaging end-to-side anastomosis is a kind of approach fitter for geometric design for internal fistula.