摘要:
Objective To investigate the clinical effect of the forearm distal basilic vein transposition vascular fistula (BVTVF) constructed with the no-touch vein separation technique. Methods 68 cases of the forearm distal BVTVF constructed in the People's Hospital of Rizhao Affiliated to Jining Medical College from December 2007 to March 2016 were analyzed retrospectively. Among them, the patients from December 2007 to December 2011 received conventional vein separation technique to separate the basilic vein (36 cases, conventional vein separation technique group), while the patients from January 2012 to March 2016 received No-touch vein separation technique (32 cases, No-touch vein separation technique group). The complications, loss rate and patency rate of the vascular fistula were compared in the 24 months observation period. Results The complication rate in the conventional vein separation technique group was significantly higher than that in the No-touch vein separation technique group during the observation period (vascular stenosis: 33.3% vs 12.5%, P=0.043; pseudoaneurysm: 38.9% vs 15.6%, P=0.033; thrombosis: 27.8% vs 6.3%, P=0.020). The loss rate of the fistula in the conventional vein separation technique group was significantly higher than that in the no-touch vein separation technology group (36.1%vs 12.5%, P=0.025). The postoperative patency rate of the fistula in the conventional vein separation technique group was significantly lower than that of the fistula in the no-touch vein separation technique group (63.9%vs 87.5%, P=0.032). Conclusion Compared with the conventional vein separation technique, applying the No-touch vein separation technique to construct the forearm distal BVTVF could reduce the incidence of complications and prolong the service life of the fistula.%目的 观察应用No-touch静脉分离技术分离贵要静脉构建前臂远端贵要静脉转位血管内瘘(BVTVF)的临床效果.方法 回顾性分析济宁医学院附属日照市人民医院2007年12月至2016年3月成功实施的前臂远端BVTVF手术患者68例,其中2007年12月至2011年12月的患者采用常规静脉分离技术分离贵要静脉(36例,常规静脉分离技术组),2012年1月至2016年3月的患者采用No-touch静脉分离技术分离贵要静脉(32例,No-touch静脉分离技术组),比较两组患者术后24个月的观察期内血管内瘘的并发症发生率、失功率及通畅率.结果 观察期内,常规静脉分离技术组并发症发生率均高于No-touch静脉分离技术组,两组比较差异有统计学意义(内瘘血管狭窄:33.3% 比12.5%,P=0.043;假性动脉瘤:38.9% 比15.6%,P=0.033;血栓形成:27.8% 比6.3%,P=0.020);常规静脉分离技术组患者血管内瘘失功率高于No-touch技术静脉分离组,两组比较差异有统计学意义(36.1% 比12.5%,P=0.025);常规静脉分离技术组血管内瘘通畅率经log-rank检验低于No-touch静脉分离技术组,两组比较差异有统计学意义(63.9% 比87.5%,P=0.032).结论 与应用常规静脉分离技术比较,应用No-touch静脉分离技术分离贵要静脉构建前臂远端BVTVF能够减少血管内瘘并发症发生率,延长血管内瘘的使用时间.