动静脉内瘘取栓术后早期使用的临床观察

Clinical observation of earlier use of the arteriovenous fistula after thrombus removal surgery

目的观察动静脉内瘘(arteriovenous fistula,AVF)原位取栓手术后早期使用的临床效果。方法选取AVF成熟并使用后发生血栓栓塞的维持性血液透析患者50例,随机分为对照组(n=25)和实验组(n=25),2组均行原位取栓术和内瘘吻合术,对照组在手术1月后使用内瘘,而实验组在术后1周内即开始使用内瘘,比较2组内瘘1年内的血流量、使用时间以及出现的并发症。结果①2组患者的动静脉内瘘在术后1个月、3个月、6个月、12个月的血流量,均达到235ml/min及以上,2组间无明显差异(P>0.05);②2组患者的内瘘使用时间均超过了1年;对照组出现8/25(32%)例动脉瘤、9/25(36%)例吻合口狭窄,实验组出现2/25(8%)例动脉瘤、3/25(12%)例吻合口狭窄,2组比较有统计学意义(分别=3.125,2.741,P均<0.05);皮下血肿对照组7/25(32%)例,实验组5/25(20%)例2组无统计学意义(=0.110,P>0.05);2组均未出现血管阻塞。结论 AVF原位取栓术后的早期使用不会损伤血管,影响伤口愈合,并可保证良好的血流量,是安全、有效的。

Objective To observe the effects of earlier use of the arteriovenous fistula （AVF） after thrombus removal operation. Methods We recruited 50 maintenance hemodialysis patients. Their mature AVF had been used for blood access, and then thrombosis formed in the AVE All of them were treated with the surgery of in situ thrombus removal and anastomosis of the AVE The operated AVF was reused after the surgery for one week （n=25, observation group） or for one month （n=25, control group）. Blood flux, reused period, and complications within one year were compared between the two groups. Results （a） Blood flux reached to 〉235 ml/min in the two groups （P〉0.05） after the surgery for 1,3, 6 and 12 months. （b） The AVFs were reused for blood access for more than one year in both groups. （c） Aneurysm was found in 8 cases （32%） in control group and in 2 cases （8%） in observation group （x2=3.125, P〈0.05）; anastomotic stenosis was found in 9 cases （36%） in control group and in 3 cases （12%） in observation group （x2=2.742, P〈0.05）. Hypodermal hematoma occurred in 7 cases in control group and in 5 cases in observation group （x2=0.110, P〉0.05）. No embolism was found in both groups. Conclusion The AVF after in situ thrombus removal surgery can be＇used earlier with sufficient blood access and without more injuries to the AVF and incision site.