301例自体动静脉内瘘吻合口径与动静脉内瘘通畅率的关系探讨

The relationship between the anastomosis stoma diameter and patency in 301 cases of autogenous arteriovenous fistula

目的总结探讨进行长期维持性血透的终末期肾病患者自体动静脉内瘘吻合口径与动静脉内瘘通畅率的关系。方法分析自2012年4月至2014年3月桂林医学院第一附属医院收治的301例为行长期维持性血液透析而行手术创建动静脉内瘘的终末期肾病患者的资料,记录分析不同吻合口径患者内瘘成功率、术后通畅率、术后并发症等情况。结果 301例行自体动静脉内瘘血管转流术的患者,其中吻合口径5 mm 82例,吻合口径6 mm 81例,吻合口径7 mm 81例,吻合口径8 mm 57例,术后一期吻合成功率达100%,不同吻合口组术后通畅率:术后1个月,5、6、7、8 mm吻合口径内瘘通畅率分别为93.90%、97.53%、97.53%、98.25%(P术后1个月> 0. 05);术后半年,内瘘通畅率分别为85.37%、90.12%、90.12%、91.23%(P术后半年>0.05);术后1年,内瘘通畅率分别为75.61%、86.42%、83.95%、85.96%(P术后1年>0.05);术后2年,内瘘通畅率分别为62.20%、75.31%、77.77%、77.19%(P术后2年<0.05);术后3年,内瘘通畅率分别为54.88%、61.73%、71.60%、85.96%(P术后3年<0.05),术后并发症(1个月内):术后血栓形成9例,术后手部肿胀6例,术口切口渗血9例,肢端窃血综合征1例。结论 7～8 mm的吻合口径较适宜,恰当吻合口径选择是提高自体动静脉内瘘通畅率的关键。

Objective To explore the relationship between patency rate and anastomotic stoma size of arteriovenous fistula(AVF)in patients with end stage renal disease who have entered long-term maintenance hemodialysis.Methods A total of 301 patients with end-stage renal disease accepted autogenous AVF procedure in Department of Nephrology of the First Affiliated Hospital of Guilin Medical College,from April 2012 to March 2014. The procedure success rate,postoperative patency rate and complications of patients with different anastomosis stoma size were analyzed.Results A total of 301 patients underwent autologous AVF procedure,the size of anastomotic stoma were 5mm in 82 cases,6mm in 81 cases,7mm in 81 cases,8mm in 57 cases.The primary success rate was 100%.The postoperative patency of different anastomotic group:AVF patency rate of anastomotic stoma with 5,6,7,8mm was 93.90%,97.53%,97.53%and 98.25%at postoperative 1 month,respectively(P1 month after operation>0.05);85.37%,90.12%,90.12%and 91.23%at postoperative 6 months,respectively(P6 months after operation>0.05);75.61%,86.42%,83.95%and 8.96%at postoperative 1 year,respectively(P1 year after operation>0.05);62.20%,75.31%,77.77%and 77.19%at postoperative 2 years,respectively(P2 year after operation<0.05);54.88%,61.73%,71.60%and 71.93%at postoperative 3 years,respectively(P3 years after operation<0.05).Postoperative complications(within 1 month)include 9 thrombosis,6 hand swelling,9 incision bleeding,1 acral stealing syndrome.Conclusion The proper size of anastomotic stoma is 7~8mm, and is the key to improve AVF patency rate.