改良端侧吻合结合机械及液压扩张法在动静脉内瘘术中的疗效及安全性分析

Analysis on the Efficacy and Safety of Modified End-to-Side Anastomosis Combined with Mechanical and Hydraulic Distension in Arteriovenous Fistula

目的观察采用改良端侧吻合结合机械及液压扩张法动静脉内瘘术在尿毒症晚期需行血液透析治疗患者中的效果及安全性。方法选择我院收治的尿毒症患者90例,其中2014年11月至2015年12月采用传统端侧吻合内瘘术的患者45例为对照组,2016年1月至2017年3月采用改良端侧吻合结合机械和液压扩张法动静脉内瘘术的患者45例为干预组,比较两组患者治疗后的吻合管径、头静脉血流量、手术优良率、手术成功率以及并发症发生率。结果干预组的吻合管径、头静脉血流量及手术优良率均显著高于对照组(P<0.05),两组患者的手术成功率无统计学差异(P>0.05)。对照组和干预组的术后并发症发生率分别为20.00%和8.89%,差异无统计学意义(P>0.05)。结论对于尿毒症晚期血液透析患者,改良端侧吻合结合机械及液压扩张法动静脉内瘘术的手术优良率较高,且不增加术后并发症,为患者的治疗提供了较好的基础,具有较高的临床应用价值。

Objective To observe the efficacy and safety of arteriovenous fistula by modified end-to-side anastomosis combined with mechanical and hydraulic distension in advanced uremia patients who need hemodialysis treatment. Methods 90 cases of patients with advanced uremia admitted to our hospital were selected. 45 cases from November 2014 to December 2015 who had traditional end-to-side anastomosis were set as the control group, and 45 cases from January 2016 to March 2017 who had arteriovenous fistula by modified end-to-side anastomosis combined with mechanical and hydraulic distension were set as the intervention group. After treatment, the anastomotic diameter, cephalic vein blood flow, excellent and good rate of surgery, success rate of surgery and incidence of complications were compared between the two groups. Results The anastomotic diameter, cephalic vein blood flow, as well as excellent and good rate of surgery of the intervention group were significantly higher than those of the control group（P〈0.05）. No statistical difference was found between two groups in the success rate of surgery（P〈0.05）. The incidences of postoperative complications of the intervention group and the control group were 8.89% and 20.00% respectively, with no statistical difference between the two groups（P〈0.05）. Conclusions For advanced uremia patients with hemodialysis, modified end-to-side anastomosis combined with mechanical and hydraulic distension for arteriovenous fistula has a good success rate of surgery and does not increase the postoperative complications, which provides a good basis for the treatment of patients and has high clinical application value.