维持性血透患者上肢自体动-静脉内瘘制作方法的比较

摘要

目的 探讨上肢3种不同手术部位和吻合方法的自体动-静脉内瘘在维持性血液透析中的临床应用效果.方法 采用显微外科技术为322例维持性血液透析患者建立上肢自体动-静脉内瘘,根据手术部位和血管吻合方法不同分为3组:腕部标准内瘘215例(A组),肘部端侧吻合内瘘组54例(B组),肘部侧侧吻合内瘘组53例(C组).比较术后2周和4周内瘘血流量、术后至开始应用时间、1、2年通畅率及并发症.结果 A组术后2周和4周内瘘血流量低于其他两组,术后至开始应用时间长于其他两组(P＜0.05);3组的1、2年通畅率无统计学差异;B组血栓形成、假性动脉瘤发生率高于其他两组(P＜0.05).结论 肘部侧侧吻合内瘘具有和腕部标准内瘘一样并发症少的优点,又具有肘部端侧吻合内瘘成熟快、血流量高的优点.%Objective To compare the clinical outcomes of three kinds of operative sites and anastomosis methodes for establishing an autogenous arteriovenous fistula in the patients with maintainance hemodialysis. Methods The autogenous arteriovenous fistula was established in 322 patients with maintenance hemodialysis by three kinds of methods of wrist typical fistula(group A. 215 cases), elbow end to side anastomosis fistula (group B,54 cases) and elbow side to side anastomosis fistula (group C, 53 cases). The clinical outcomes and complications were compared. Results The volume of fistula blood flow on the 2nd and 4th week after fistula establishment was lower in group A than that in groups of B and C(P<0. 05). The time from surgery to the beginning of utilization was longer in group A than that in groups of B and C(P<0. 05). The 1- and 2-year patency rates of three groups were similar. The incidence rates of thrombosis and false aneurysm were higher in group B than those in groups of A and C(P<0. 05). Conclusion The establishment of autogenous arteriovenous fistula with elbow side to side anastomosis technique has the advantages of higher volume of fistula blood flow, earlier maturity and less complications.