两种不同部位透析用动-静脉内瘘成形术的手术效果评估和治疗体会

Operative outcome and experience in arteriovenous shunt at different sites

目的 评估两种不同部位透析用前臂桡动脉 头静脉内瘘成形术的手术成功率及瘘管半年通畅率 ,总结治疗经验 ,以期进一步提高手术效果。方法 回顾性分析北京安贞医院 7年来 10 2例前臂桡动脉—头静脉内瘘成形术患者的临床资料 ,比较腕部及鼻烟窝部两不同手术部位等因素对手术成功率及瘘管半年通畅率的影响并作统计学分析。结果 两种手术部位对一次手术成功率无影响 ,腕部手术瘘管半年通畅率好于鼻烟窝部手术。而性别、年龄、原发病等因素对手术成功率及瘘管半年通畅率均无影响。吻合口内膜增生、血管本身条件、血管吻合技术是导致手术失败及瘘管闭塞的重要影响因素。结论 吻合口是否内膜增生、桡动脉和头静脉的直径、动静脉内膜是否光滑及远段流出道的好坏、手术及吻合技巧、血管吻合角度、动静脉之间的距离以及患者自身的保护等是保障动静脉瘘手术成功及通畅的重要因素。鼻烟窝部血管条件较好者 ,还应以此部位手术为首选。

Objective To summarize and analyze the influencing factors of both success and half-year patency rate of radial artery-cephalic vein arteriovenous fistula. Methods A retrospective analysis was made on the clinical data of 102 patients with chronic renal failure undergoing radial artery-cephalic vein arteriovenous shunt for hemodialysis during 7 years and the influence of different factors: sex, age, primary disease, incision site, and situations of vessels on the operative success rate and the half-year patency rate of the fistula was compared. Results No significant difference in the initial success rate of operation was found between the operations performed at the two different incision sites: at the wrist and at anatomist′s snuffbox. However, the operation at the wrist was better than that at anatomist′s snuffbox with regard to the half-year patency rate. Both operative success rate and half-year patency rate were not influenced by patient′s sex, age, and primary disease. Anastomotic hyperplasia, condition of blood vessel and anastomotic technique were important factors influencing the operative failure and fistula occlusion. Conclusion Correct selection of incision site is of key importance for both operative success and maintenance of half-year patency of radial artery-cephalic vein arteriovenous fistula. In addition, anastomotic hyperplasia, diameter and intimal smoothness of selected blood vessel, condition of run-off vessel, operative technique, anastomotic angle, distance between artery and vein, and patient′s self-protection are also considered important influencing factors.