自体动静脉内瘘侧侧吻合的临床运用优势

Clinical advantages of side-to-side anastomosis of arteriovenous fistula

目的观察自体动静脉内瘘侧侧吻合的使用情况以评估其临床运用优势。方法选取我院2015年12月至2016年12月接受自体动静脉内瘘成形术患者67例,按手术方式的不同分为侧侧吻合组(观察组,n=35)和功能性侧侧吻合组(对照组,n=32),观察2组内瘘成熟时间、首次手术成功率,并对其进行为期1年的随访,比较术后并发症,可穿刺血管长度(采用可穿刺血管长度/腕横纹至肘横纹长度)。结果 2组患者内瘘成熟时间、透析中平均血流量、首次手术成功率等内瘘相关临床指标比较无明显差异(P> 0. 05);术后随访1年,观察组并发症发生率为11. 4%,对照组并发症发生率为31. 25%,2组比较差异有统计学意义(P <0. 05);观察组可穿刺血管长度显著高于对照组,差异有统计学意义(P <0. 05)。结论前臂或上臂动静脉侧侧吻合可有效地利用有限的血管资源,减少术后血栓发生率,延长动静脉内瘘使用年限。

Objective To observe the clinical application of side-to-side anastomosis of arteriovenous fistula( AVF) so as to evaluate its clinical advantages. Methods A total of 67 cases of arteriovenous fistuloplasty were selected in our hospital from December 2015 to December 2016. They were randomly divided into two groups: the observation group( side-to-side anastomosis,n = 35) and the control group( functional end-to-side anastomosis,n = 32). The maturation time of the AVF and the success rate of the first operation were observed in the two groups. The patients were followed up for 1 year to compare the postoperative complications and the length of the puncture vessel. Results There was no significant differences between the two groups in the time of internal fistula maturation,mean blood flow during dialysis,and the success rate of first operation( P > 0. 05). After 1 year of follow-up,the incidence of complications in the observation group was 11. 4% and the control group was 31. 25%,the difference in incidence of complications between two groups was significantly( P < 0. 05). The length of puncture vascular in the observation group was significantly higher than that of the control group( P < 0. 05). Conclusion Side-to-side anastomosis of AVF in the forearm or upper arm can effectively use the limited vascular resources,reduce the incidence of complications and prolong the service life of AVF.