端侧吻合法建立终末期肾脏病血液透析病人前臂细小头静脉血管动静脉内瘘15例

Establishment of 15 cases of arteriovenous fistula of small cephalic vein of forearm in hemodialysis patients with end-stage renal disease by end-to-side anastomosis

目的探讨端侧吻合法建立前臂直径<2.0 mm头静脉血管动静脉内瘘(arteriovenous fistula,AVF)的效果,为预测直径<2.0 mm头静脉血管是否能建立AVF提供参考。方法回顾性分析2018年1月至2019年9月在合肥市滨湖医院建立AVF并且留在血液净化中心透析的终末期肾脏病病人30例。根据术前超声测量头静脉管腔直径大小,分为观察组(头静脉血管直径<2.0 mm)和对照组(头静脉血管直径>2.0 mm),各15例。超声测量两组术前和术后的头静脉、桡动脉和术后瘘口直径和平均血流流速,记录首次上机透析时间,透析12周后采集透析时的血泵血流量、有效血流量和动脉压,评价AVF功能及成功率。结果对照组均一次性成功建立AVF,成功率100%(15/15)。观察组中12例一次性成功建立,1例二次手术后成功建立,1例术后12周后经球囊扩张后可以使用,1例选择颈内半永久管作为长期血管通路,首次成功率80%(12/15),总成功率93%(14/15)。观察组和对照组首次使用时间分别为(40.14±13.26)d和(31.00±4.77)d,与对照组相比,观察组明显延后(P<0.05)。术后4周观察组和对照组的瘘口直径分别为(3.41±0.08)mm和(4.15±0.65)mm,两组比较差异有统计学意义(P<0.05)。术后4周观察组和对照组的头静脉直径分别为(3.87±0.81)mm和(4.74±0.99)mm,两组比较差异有统计学意义(P<0.05)。透析12周后观察组和对照组透析时有效血流量分别为(247.8±20.60)mL/min和(263.60±22.59)mL/min,两组比较差异有统计学意义(P<0.05)。结论端侧吻合法在前臂位置同样适合建立头静脉管腔直径<2.0 mm病人的AVF,但需要较长的成熟期,成熟后基本不影响透析。

Objective To investigate the effect of end-to-side anastomosis on the establishment of arteriovenous fistula(AVF)with diameter less than 2.0 mm in forearm position,and to provide a reference for predicting whether the small cephalic vein can establish AVF.Methods A retrospective study of 30 cases of end-stage renal disease patients who had established AVF in Binhu Hospital of Hefei from January 2018 to September 2019 was conducted.The patients were assigned into observation group and control group according to the diameter of cephalic vein measured by preoperative ultrasound,each group with 15 cases.The cephalic vein,radial artery,fistula diameter and mean flow velocity of preoperative or and postoperative were measured by ultrasound.The time of first dialysis was recorded.The blood pump blood flow,effective blood flow and arterial pressure were collected after 12 weeks of dialysis.The above data were statistically analyzed to evaluate the function and success rate of AVF.Results AVF was successfully established in all 15 patients in the control group,and the success rate was 100%(15/15).Twelve of the 15 patients in the observation group were successfully established at one time.One case of observation was successfully established after the second operation.One case of observation could be used 12 weeks after operation by balloon dilatation,and one case of observation chose the internal cervical semi-permanent tube as a long-term vascular access.The first success rate was 80%(12/15)and the total success rate was 93%(14/15)in observation group.The first use time of observation group and control group was(40.14±13.26)days and(31.00±4.77)days,respectively.Compared with the control group,the observation group was significantly delayed(P<0.05).The diameter of the fistula in the observation group and the control group was(3.41±0.08)mm and(4.15±0.65)mm in 4 weeks after the operation.The difference was statistically significant(P<0.05).The diameter of the cephalic vein in the observation group and the control group was(3.87±0.81)mm and(4.74±0.99)mm in 4 weeks after the operation.The difference was statistically significant(P<0.05).After 12 weeks of dialysis,the effective blood flow in the observation group and the control group was(247.8±20.60)ml/min and(263.60±22.59)ml/min,respectively.The difference was statistically significant(P<0.05).Conclusion The end-to-side anastomosis is also suitable for establishing AVF of patients with cephalic vein diameter less than 2.0 mm in forearm,but it needs a long maturation period and does not affect dialysis after maturation.