前臂自体动静脉内瘘日间手术的临床疗效

Clinical application of day surgery for forearm arteriovenous fistula construction

目的探讨前臂自体动静脉内瘘日间手术的临床疗效。方法回顾性分析2016年4月至2018年12月在首都医科大学附属北京友谊医院日间手术病房行前臂远端自体动静脉内瘘的27例患者的相关临床资料。患者经肾内科或肾移植科确诊终末期肾病,愿意接受血液透析治疗,转诊至血透通路专病门诊。完善术前检查,除外手术禁忌后,在日间手术住院系统内登记预约手术。当日日间病房手术结束后,患者在日间病房观察1 h,生命体征稳定,手术医师确认患者可以出院后,安排患者出院。观察患者手术时间(入手术间至离开手术间),日间病房住院时间(进入日间病房至离开日间病房),术后并发症情况,术后内瘘成熟率。结果患者平均手术时间为95. 6 min。患者日间病房住院时间为199. 0 min。所有患者均随访至术后3个月,初次内瘘患者共24例,随访期间死亡2例,术后2周闭塞1例;随访至术后3个月时,未能成熟3例,初次成熟率为79. 2%(19/24)。再次内瘘手术修复患者4例,手术成功率为100%(4/4)。结论前臂自体动静内瘘日间手术模式是安全的,无严重并发症,且能够明显缩短患者住院时间。

Objective To explore the clinical efficacy of day surgery for forearm arteriovenous fistula construction. Methods The clinical data of 27 patients who underwent day surgery to construct arteriovenous fistula at the Beijing Friendship Hospital,Capital Medical University from April 2016 to December 2018 were retrospectively analyzed. Patients diagnosed of end-stage renal disease by nephrologist or specialist of renal transplantation were transferred to vascular access outpatient department to prepare the vascular access of hemodialysis. Accomplished routine peroperative examination and confirmed no contraindication,patients were scheduled in inpatient system of day surgery. Patients were surveyed in day surgery ward for 1 h after the day surgery of arteriovenous fistula construction. After the operator surgeon confirmed the patients meeting discharge standard,then arranged discharge of the patients. The operation time,hospital stay in day ward,postoperative complications and postoperative fistula maturity rate were observed. Results Average duration of surgery was 95. 6 min( time from entering operating room to leaving operating room). Average lenth of stay in day surgery ward was 199. 0 min. All patients were followed up for 3 months,there were 24 patients of primary arteriovenous ? stula,postoperative death 2 patients,postoperative occlusion 1 patients. 3 patients were confirmed failure maturation in 3 months,and the primary patency rate was 79. 2%( 19/24). 4 patients performed rivision of arteriovenous ? stula,success rate of operation was 100%( 4/4). Conclusion Day surgery for arteriovenous fistula construction is safe and has no severe complications. Day surgery can reduce the hospitalization of patients obviously.