彩超在尿毒症患者自体动静脉内瘘建立中的应用

Clinical value of color Doppler ultrasonography in establishment of autogenous arteriovenous fistula in uremic patients

目的探讨彩超在尿毒症患者自体动静脉内瘘建立中的应用价值。方法回顾性分析2010年9月至2016年9月在西南医院肾科行自体动静脉内瘘手术的1 895例尿毒症患者的临床资料,其中男性984例,女性911例,年龄18~79岁,平均57.2岁。根据其术前有无彩超检查定位分为物理检查组及超声检查组,比较两组手术时间及切口大小、手术一次性成功率、术前定位与最终手术部位匹配率、术后1周内瘘闭塞率、术后1个月内瘘成熟率及2个月后内瘘可穿刺率。结果超声检查组手术一次性成功率为95.8%,术前定位与最终手术部位匹配率为99.7%,2个月后内瘘可穿刺率99.8%,均明显高于物理检查组(P<0.05);手术时间为(63±18)min、手术切口为(3.1±0.4)cm,术后1周内瘘闭塞率3.9%,均明显低于物理检查组(P<0.05);术后1个月内瘘成熟率因物理检查组未常规检查无法比较。结论彩超可显著提高尿毒症患者自体动静脉内瘘手术一次性成功率、减小手术切口、缩短手术时间、降低早期闭塞率,并且通过术后的早期监测可及时发现内瘘相关并发症。

Objective To explore the clinical value of color Doppler ultrasonography in the establishment of autogenous arteriovenous fistula in the uremic patients. Methods Clinical data of 1 895 uremic patients undergoing the operation to establish internal arteriovenous fistula in our nephrology department from September 2010 to September 2016 were collected and retrospectively analyzed in this study. They were984 males and 911 females,and at an age ranging from 18 to 79（mean 57. 2）. According to with or without preoperative color Doppler ultrasound examination,they were divided into physical examination group and color Doppler ultrasonography group. Duration of surgery,length of incision,one-time success rate of surgery,matching rate of preoperative localization and final surgical site,incidence of fistula occlusion within 1 week postoperatively,rate of fistula maturation in 1 month postoperatively and puncture rate of fistula in 2 months postoperatively were compared between the 2 groups. Results In the color Doppler ultrasonography group,the one-time success rate of surgery was 95. 8%,the matching rate of preoperative localization and final surgical site was 99. 7%,the puncture rate of fistula in 2 months postoperatively was 99. 8%,and all of the indicators were significantly higher than those of the physical examination group（P〈0. 05）. What＇s more,the duration of surgery was 63 ± 18 min,length of incision was 3. 1 ± 0. 4 cm,rate of fistula occlusion within1 week postoperatively was 3. 9%,and all of them were obviously lower as compared with those of the physical examination group（P〈0. 05）. Due to no routine examination in the physical examination group,the rate of fistula maturation 1 month postoperatively could not be compared. Conclusion Application of color Doppler ultrasonography in the establishment of autogenous arteriovenous fistula can significantly increase one-time success rate of surgery,and decrease length of incision,duration of surgery and early occlusion rate in the patients with uremia. Early postoperative monitoring is helpful to find detect fistula related complications timely.