动静脉内瘘成形术在基层医院开展的体会

ARTERIOVENOUS FISTULA OPERATION IN THE PRIMARY HOSPITALS

目的探讨尿毒症患者建立自体动静脉内瘘的手术方式。方法分析285例行AVF成形术患者手术方式的选择、术前准备、操作要点及术后注意事项等。结果 285例患者手术成功率为90.88%,其中前臂为90.83%(198/218),上臂为91.04%(61/67),二者比较没有统计学意义(P>0.05)。糖尿病、非糖尿病肾病患者的前臂及上臂自体AVF成形术成功率比较没有统计学意义(P>0.05)。糖尿病与非糖尿病肾病患者AVF成形术总成功率比较有统计学意义(P<0.01)。结论尿毒症患者行前臂及上臂AVF成形术均有较好的效果,但从手术难度来看,应首选前臂。

Objective To explore the operative methods of constructing autologous arteriovenous fistula （AVF） in uremic patients. Methods The surgical approach, preoperative preparation, operating instruc- tions and postoperative precautions of 285 cases undergoing AVF operation were analyzed. Results The sur- gical success rate was 90.88% in the 285 cases. The surgical success rate was 90.83% in forearms （198 / 218） and 91. 04% （61/ 67） in the upper arm （P〉 0.05）. No significant difference in the success rate of AVF operations on forearms and upper arms of diabetics and non-diabetic nephropathy patients was found （P〉 0.05）, but significant difference in the total success rate of A VF operations in diabetics and non-dia- betic nephropathy patients （P 〈0.01）. Conclusion AVF operation for uremia patients can produce good curative effects but may be mainly chosen for forearms due to the degree of operative difficulty.