建立动静脉内瘘458例分析

Analysis of 458 cases of arteriovenous fistula plasty

目的:探讨终末期肾病患者动静脉内瘘建立的手术方式及手术经验,提高对动静脉内瘘的手术的认识。方法:2004～2008年间动静脉内瘘成形手术458例,分析手术方式的选择、操作要点、成功率及并发症等。结果:动静脉内瘘成形手术总体成功率95%,前臂自体动静脉内瘘成形术、肘窝部自体动静脉内瘘成形术和人工血管移植动静脉内瘘成形术之间手术成功率无显著差别(P>0.05),自体静脉移植内瘘术较低(P<0.05)。原发病为糖尿病和(或)高血压肾病患者的动静脉内瘘手术成功率明显低于非糖尿病和(或)高血压肾病患者(P<0.05)。结论:动静脉内瘘的首选是前臂自体动静脉内瘘,其次是人工血管移植动静脉内瘘或肘窝部自体动静脉内瘘。继发于糖尿病和(或)高血压肾病患者动静脉瘘成形术成功率较低,应更注意手术指征和手术技巧的把握。

Objective： To study the mode and experience of arteriovenous fistula operation in patients with end stage renal disease, and to reinforce the knowledge about arteriovenous fistula operation. Methods： 458 cases of arteriovenous fistula（AVF） operation in 2004-2008 were analyzed about the selection of operation style, operalion technique,achievement ratio and complication. Results：Overall achievement ratio of AVF was 95%. The achievement ratios were not significantly different among native forearm AVF operation, autogenous elbow AVF operation and AVF vascular prosthesis graft operation （P〉0.05）. but the achievement ratio of AVF autogenous vein graft operation was lower. The achievement ratio of AVF with diabetes or/and hypertension was lower than that of others （P〈0.05）. Conclusion： The first selection of AVF is native forearm AVF and the next is AVF vascular prosthesis graft or autogenous elbow AVF operation. The achievement ratio of AVF with diabetes or/and hypertension is lower.We shoud pay more attention to operation indicatios and operation skill.