腕部桡动脉、头静脉端端吻合与端侧吻合在尿毒症动静脉内瘘术中的应用效果比较

Comparison of the application effect of radial artery and cephalic vein end-to-end anastomosis and end-to-side anastomosis in uremic arteriovenous fistula

目的比较腕部桡动脉、头静脉端端吻合与端侧吻合在尿毒症动静脉内瘘术中的应用效果。方法采用回顾性分析,观察对象为2020年1月至2022年1月菏泽市中医医院入院的76例尿毒症患者,所有患者均接受动静脉内瘘术治疗,根据不同吻合方式分为研究组(n=38)与对照组(n=38)。研究组行腕部桡动脉、头静脉端端吻合,对照组行腕部桡动脉、头静脉端侧吻合。比较两组患者手术前后的生活质量(躯体健康、躯体角色、疼痛、情绪角色、活力、心理功能、社会功能、总体健康)评分与吻合手术时间、吻合口直径、吻合口血流量、吻合成功率、术后1年吻合通畅率、并发症(通路感染、迟发性血栓、盗血综合征、吻合口狭窄)发生率。结果两组患者的术后生活质量(躯体健康、躯体角色、疼痛、情绪角色、活力、心理功能、社会功能、总体健康)评分较均术前明显升高,且研究组术后生活质量评分明显高于对照组,差异均有统计学意义(P<0.05)。研究组患者的吻合手术时间为(21.24±3.58)min,明显短于对照组[(30.59±5.22)min],吻合口直径为(5.43±1.28)mm,明显长于对照组[(4.31±1.04)mm],吻合口血流量与吻合成功率、术后1年吻合通畅率分别为(238.53±18.71)mL/min、97.37%、89.47%,均明显高于对照组[(184.32±10.27)mL/min、78.95%、60.53%],并发症发生率为5.26%,明显低于对照组(26.32%),差异均有统计学意义(P<0.05)。结论腕部桡动脉、头静脉端端吻合法在尿毒症动静脉内瘘术中的应用效果优于端侧吻合法,可有效缩短吻合手术时间,扩大吻合口直径,增加血流量,还可提升吻合成功率、吻合通畅率及患者的生活质量,且并发症更少,安全性高。

Objective To compare the application effect of radial artery and cephalic vein end-to-end anastomosis and end-to-side anastomosis in uremic arteriovenous fistula.Methods Using retrospective analysis as the method,the observation objects were 76 patients with uremia who were admitted to Heze Hospital of Traditional Chinese Medicine from January 2020 to January 2022.All patients received arteriovenous fistula surgery and were divided into the study group according to different anastomosis methods(n=38)and the control group(n=38).End to end anastomosis of radial artery and cephalic vein was performed in the study group,and end to side anastomosis of radial artery and cephalic vein was performed in the control group.The scores of quality of life(physical health,physical role,pain,emotional role,vitality,psychological function,social function,and overall health)before and after surgery were compared between the two groups of patients,as well as the anastomotic operation time,anastomotic diameter,anastomotic blood flow,and anastomotic success rate.1-year postoperative anastomotic patency rate,incidence of complications(access infection,delayed thrombosis,steal syndrome,anastomotic stenosis).Results The scores of quality of life(physical health,physical role,pain,emotional role,vitality,psychological function,social function,and overall health)in the two groups after operation were significantly higher than those before operation,the postoperative quality of life score of the study group was higher than that of the control group,and the differences were statistically significant(P<0.05).The anastomotic operation time of the patients in the study group was(21.24±3.58)min,which was significantly shorter than that of the control group[(30.59±5.22)min],the diameter of the anastomotic orifice was(5.43±1.28)mm,which was significantly longer than that of the control group[(4.31±1.04)mm],the anastomotic blood flow and the anastomotic success rate,and the anastomotic patency rate one year after operation were(238.53±18.71)mL/min,97.37%,89.47%,which were significantly higher than that of the control group[(184.32±10.27)mL/min,78.95%,60.53%],the complication rate was 5.26%,which was significantly lower than that of the control group(26.32%),and the differences were statistically significant(P<0.05).Conclusion The application effect of forearm radial artery and cephalic vein end to end anastomosis in uremic arteriovenous fistula is better than that of end to side anastomosis,which can effectively shorten the anastomosis time,expand the diameter of anastomosis,increase blood flow,improve the success rate of anastomosis,anastomosis patency rate and quality of life,with fewer complications and high safety.