肘部改良自体动静脉内瘘手术与肘部传统内瘘手术的评价研究

The evaluation study of improved elbow arteriovenous fistula and traditional elbow arteriovenous fistula

目的评价维持性血液透析患者肘部改良自体动静脉内瘘手术与传统肘部动静脉内瘘术的应用效果;方法对84例行肘部改良内瘘术患者及79例传统内瘘术患者进行4年的随访研究。比较各组透析期间血管直径、可用血管长度、平均血流量及内瘘通畅率情况。并统计2组患者血栓、动脉瘤、前臂水肿、心力衰竭等并发症的发生率,以此来判定2种术式的优缺点;结果 2组患者内瘘成熟后均可满足血液透析需求。术后3月传统内瘘术组内瘘平均血流量高于改良内瘘术组(1101.66±189.66ml/min比1199.46±197.23ml/min,P=0.002),改良内瘘术组可用血管长度明显高于传统内瘘术组(15.24±1.17cm比20.59±1.63cm,P<0.001),2组术式血管直径无显著差异(6.30±0.59mm比6.20±0.62mm,P=0.284)。2组前2年内瘘通畅率无明显差异(P>0.05),第3年改良内瘘术组内瘘通畅率高于传统内瘘术组(P=0.045)。在并发症方面传统内瘘术组血栓发生率高于改良内瘘术组(P=0.047),改良内瘘术组前臂水肿发生率高于传统内瘘术组(P=0.037),两组患者在心力衰竭、动脉瘤等并发症发生率无显著差异(P>0.05);结论 2组动静脉内瘘术式血流量均较好且通畅率高,肘部改良自体动静脉内瘘术较传统肘部动静脉内瘘术可显著延长穿刺用血管长度,但前臂水肿发生率高于传统内瘘术组,有待于进一步对术式进行改良。

Objective To compare vascular access and complications between improved elbow arteriovenous fistula（AVF） and traditional elbow AVF in maintenance hemodialysis patients. Methods Eight-four patients with improved elbow AVF surgery and 79 patients with traditional elbow AVF surgery were followed up for 4 years. Fistula diameter, vascular length useful for blood access, average blood flow, and fistula patency during dialysis period were compared between the two groups. Thrombus, aneurysm, forearm edema, heart failure were recorded to evaluate complications in the two groups. Results Both of the two kinds of AVFs met the requirements for hemodialysis. In improved elbow AVF group and traditional elbow AVF group after the surgery for 3 months, the average blood flow was 1101.66 ± 189.66 ml/min and 1199.46 ± 197.23 ml/min（P =0.002）, respectively; vascular length available for blood access was 20.59 ± 1.63 cm and 15.24 ± 1.17 cm（P0.001）, respectively; blood vessel diameter was 6.30±0.59 mm and 6.20±0.62 mm（P =0.284）, respectively. The fistula patency rate was similar（P0.05） in the first two years between the two groups, but was higher（P=0.045） in the first three years in the improved elbow AVF group. The incidence of thrombosis was higher in traditional elbow AVF group（P=0.047）, but the incidence of forearm edema was higher in improved elbow AVF group（P=0.037）. The incidence of heart failure and aneurysm were similar between the two groups（P0.05）. Conclusions Both of the two groups yielded sufficient blood flow and higher patency rate. The improved AVF surgical method obtained longer vessel for blood access but with higher rate of forearm edema.