副头静脉对前臂动静脉内瘘早期失功的影响

Effects of accessory vein on the early fistula failure of forearm arteriovenous fistulas

目的探讨副头静脉对前臂动静脉内瘘早期失功的影响。方法选择38例首次行动静脉内瘘术的尿毒症患者,所有患者都有副头静脉,随机分成实验组19例和对照组19例。实验组对副头静脉用丝线结扎阻断,对照组不处理副头静脉,2组均行前臂标准动静脉端侧吻合术。术后8w、20w比较2种方法对动静脉内瘘血流量、早期失功率的影响。结果术后8w实验组头静脉血流量好于对照组,2组存在统计学意义(t=3.402,P=0.002);早期内瘘失功率好于对照组,2组差异存在统计学意义(χ~2=4.502,P=0.034)。术后20w实验组头静脉血流量好于对照组,2组存在统计学意义(t=3.102,P=0.004);早期内瘘失功率好于对照组,2组差异存在统计学意义(χ~2=5.246,P=0.022)。结论副头静脉的存在会导致动静脉内瘘血流量减少,早期内瘘失功率增加,副头静脉的处理对前臂动静脉内瘘术至关重要。

Objective To investigate the effect of accessory vein on the early failure of forearm arteriovenous fistula. Methods A total of 38 uremia patients who underwent arteriovenous fistula surgery for the first time were randomly divided into experimental group （n=19） and control group （n=19）. During the surgery, the accessory vein was blocked by thread ligation in the experimental group, and had no treatment in the control group. Both groups received standard end-to-side arteriovenous anastomosis in forearm. After operation for 8 and 20 weeks, the effects of the two surgical methods on blood flow and early fistula failure were compared. Results After operation for 8 weeks, blood flow rate was higher in the experimental group than in the control group （t=-3.402, P=0.002）; early fistula failure ratio was lower in the experimental group than in the control group （χ^2=4.502, P=0.034）. After operation for 20 weeks, blood flow rate was still higher in the experimental group than in the control group （t=-3.102, P=0.004）, and early fistula failure ratio was lower in the experimen- tal group than in the control group （χ^2=5.246, P=0.022）. Conclusion The presence of the accessory vein can decrease the blood flow in arteriovenous fistula and increase the ratio of early fistula failure. The treatment of the accessory vein is important for the forearm arteriovenous fistula.