两种不同吻合方法在前臂动静脉内瘘手术中的随机对照研究

Two different anastomosis methods for arteriovenous fistula plasty of forearm in hemodialysis patients：a randomized controlled study

目的比较间断结节吻合与连续吻合两种不同方法在前臂动静脉内瘘手术中的临床效果，结合文献总结治疗经验，以期进一步提高手术效果。方法76例施行前臂动静脉内瘘术的患者被随机分为两组：其中间断结节吻合38例，连续吻合38例，两组均采用端一侧吻合。比较两种吻合方法在血管吻合时间、总体手术时间、术后血管通畅度及血管并发症的差异并作统计学分析。结果血管吻合时间问断结节吻合组平均为（27．4±5．2）min、连续缝合组为（18．4±4．6）min，差异具有统计学意义（P〈0．05）；总体手术时间间断结节吻合组平均为（68．6±18．4）min、连续缝合组为（54．8±12．2）min；差异具有统计学意义（P〈0．05）。内瘘成熟后血流量间断结节吻合组平均为（647．6±102．8）ml／min、连续吻合组为（604．8±82．5）ml／min，差异具有统计学意义（P〈0．05）。术后1个月、6个月和1年通畅率分别为间断结节吻合组100％（38／38）、97．4％（37／38）、97．4％（37／38），连续缝合组97．4％（37／38）、94．7％（36／38）、94．7％（36／38）；两组间均无统计学差异（P〉0．05）。结论连续吻合建立动静脉内瘘血管吻合时间及总体手术时间比间断结节吻合更短，而近远期通畅率与间断吻合无明显差异，但内瘘成熟后血流量较间断结节吻合小。因此，采用个体化方案决定吻合方式可能对患者更有利。

Objectives To compare the efficacy of discontinuous anastomosis and continuous anastomosis for arteriovenous fistula plasty of forearm in hemodialysis patients, referring to the literature and summarize our experi- ence to improve the operation outcome. Methods Totally 76 patients operating for arteriovenous fistula plasty of forearm were randomized divided into 2 groups： 38 patients received discontinuous anastomosis and 38 patients received continuous anastomosis. The two groups were all used for end - to - side anastomosis. Comparing the time of vascular anastomosis ,total operation time ,patency rates and complications and make statistical analysis. Results The mean time of vascular anastomosis are （ 27.4 ± 5.2 ） min and （ 18.4 ± 4.6 ） min in discontinuous anastomosis group and continuous anastomosis group respectivly, with a statistical significant difference （ P 〈 0. 05 ） ; The mean to- tal operation time are （68.6 ± 18.4）rain and （54.8 ± 12.2 ）min in discontinuous anastomosis group and continuous anastomosis group respectivly ,with a statistical significant difference（ P 〈0.05 ）. The average blood flow after mature formation of fistulas in the discontinuous anastomosis group was（647.6 ± 102.8 ）ml/min,while that in the continuous anastomosis group was （604.8 ± 82.5 ） ml/min, with a statistical difference （ P 〈 0.05 ）. The 1 - month ,6 - month,and 12 -month patency rates in discontinuous anastomosis group and continuous anastomosis group were 100% （38/38） ,97.4% （37/38） ,97.4% （37/38） and 97.4% （37/38） ,94.7% （36/38） ,94.7% （36/38） respectivly, witn no statistical difference（ P 〉 0.05 ）. Conclusions The continuous anastomosis for arteriovenous fist - ula plasty can get a shotter time both in vascular anastomosis and total operation procedure than the discontinuous anastomosis, and the short - term and long - term patency rates are similar, but the blood flow after mature formation of fistulas was smaller than the discontinuous anastomosis. Thus, according to the patients＇individual condition to decide different anastomosis methods could be more beneficial for the patients.