胸壁与上肢人工血管透析通路的通畅率及影响因素比较

Arteriovenous Axillary Loop Graft for Hemodialysis Access: Comparing Patency Rates and Related Factors with Upper Limb Arteriovenous Graft

目的评估胸壁人工血管透析通路（arteriovenous axillary loop graft,AVALG）的临床疗效,比较与上肢（前臂、上臂）人工血管透析通路在通畅率及其影响因素的区别。方法回顾性分析2008年6月~2015年9月我科实施人工血管动静脉瘘术（arteriovenous graft,AVG）69例（98例次）终末期肾病资料。前臂AVG 44例（64次）,上臂AVG 11例（20次）,AVALG 14例（14次）。应用生存曲线、log-rank检验、Cox多因素回归分析等比较通畅率及并发症的差异,探讨通畅率的影响因素。结果前臂AVG、上臂AVG、AVALG的6个月和1年初级通畅率分别为59.5%、56.3%、92.8%和43.7%、49.1%、92.8%,次级通畅率分别为82.3%、78.9%、92.8%和72.5%、68.8%、92.8%,AVALG的初级通畅率及次级通畅率均显著高于前臂、上臂AVG（P〈0.05）。Cox多因素分析显示多次通路失功史（P=0.016）、人造血管通路位置（P=0.005）和术后抗栓治疗（P=0.005）为独立预测因素。AVALG组并发症发生率50%（7/14）,上臂和前臂AVG并发症发生率67.9%（57/84）,差异无显著性（χ^2=1.689,P=0.194）。结论 AVALG在双上肢动静脉瘘多次失功、双上肢血管资源耗竭的透析患者中具有重要临床应用价值。

Objective To evaluate the role of arteriovenous axillary loop graft（ AVALG） for establishing hemodialysis access,and to compare its patency rates and related factors with upper limb arteriovenous graft（ AVG）. Methods A total of 69 patients with end-stage renal diseases who underwent AVG（ 98 grafts） for hemodialysis access in our department from June 2008 to September 2015 were retrospectively reviewed. Among them,44 patients underwent 64 forearm AVG,11 patients underwent 20 upper arm AVG,and 14 patients underwent 14 AVALG. The information of their gender,age,medical history,surgery procedure,patency rate,and complications was collected and compared by using survival curves,the log-rank test,Cox multiple factors regression analysis test. Results The primary patency rates at 6 months /1 year were 92. 8% /92. 8% for AVALG,56. 3% /49. 1% for upper arm AVG,and 59. 5% /43. 7% for forearm AVG. The secondary patency rates at 6 months /1 year was 92. 8% /92. 8% for AVALG,78. 9% /68. 8% for upper arm AVG,and 82. 3% /72. 5% for forearm AVG. The AVALG had the highest primary and secondary patency rates（ P 〈0. 05）. History of multiple vascular access failure（ P = 0. 016）,different locations of AVG（ P = 0. 005） and different postoperative antithrombotic drug regimens（ P = 0. 005） were significantly associated with primary patency rates in multivariate analysis. Postoperative complication rate was 50%（ 7 /14） for AVALG and 67. 9%（ 57 /84） for upper limb AVG. There was no significant difference in postoperative complications between AVALG and upper limb AVG（ χ2= 1. 689,P = 0. 194）.Conclusion AVALG can play an important role in chronic renal failure patients with inadequate upper extremity access.