296例维持性血液透析患者动静脉内瘘建立的临床分析

Clinical Analysis of Internal Arteriovenous Fistula Establishment of 296 Maintenance Hemodialysis Patients

[目的]探讨建立血液透析（HD）通路的时机及提高手术成功率和远期通畅率的影响因素.[方法]回顾性分析296例尿毒症患者（321次）动静脉内瘘建立的情况.[结果]上肢自体动静脉内瘘（AVF）一期成功率96.51%,而肘部、下肢自体AVF及人工血管AVF术为100%.人工血管AVF较自体AVF成熟时间短（P〈0.05）.鼻烟窝及人工血管内瘘较易发生血栓形成（P〈0.05）;而端-侧吻合较少（P〈0.05）;肘窝、下肢自体AVF及人工血管AVF内瘘易成熟（P〈0.05）.[结论]腕部头静脉-桡动脉端-侧吻合（标准内瘘）是首选;改良侧-侧吻合对血管条件好的患者亦有较高成功率;人工血管内瘘为自体内瘘失败者提供了更多的选择.

[Objective] To explore the time of the establishment of hemodialysis access, and the factors for improving success rate of surgery and long-term patency rate. [Methods]A total of 296 uremia patients who established hemodialysis access were analyzed retrospectively. [Results] The one-stage successful rate of au- tologous arteriovenous fistula（AVF） in upper extremity was 96.51%, and the successful rate of AVF in cubital fossa and lower extremity and artificial blood vessel arteriovenous fistula was 100%. The maturation time of artificial vessel AVF was shorter than that of autologous AVF（ P 〈0.05）. Compared to other parts of fistula thrombosis, snuffbox fistula and artificial blood vessels had high incidence（ P〈0.05）. But the incidence of thrombosis of end-side anastomosis was lower（ P 〈0.05）. In the maturation, all the cubital fossa AVF, lower extremity autologous AVF and artificial vessel AVF had obvious advantages（ P 〈0.05）. [Conclusion] The end-side anastomosis of wrist cephalic vein and radial artery （standard fistula） is first choice. Modified side-side anastomosis for patients with good vascular conditions has relatively high successful rate. Artificial vessel AVF provides more good options for patients whose autologous fistulas are failure.