中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (11): 681-685.doi: 10.3969/j.issn.1671-4091.2015.11.010

• 血管通路 • 上一篇    下一篇

细小血管动静脉内瘘术方案选择的临床研究

张凡1,陶杰2,王涛1,吴晓波2,莫立稳1,程悦1,朱军1   

  1. 1. 成都军区总医院肾内科
    2. 成都军区总医院超声科
  • 收稿日期:2015-04-27 修回日期:2015-08-10 出版日期:2015-11-12 发布日期:2015-11-12
  • 通讯作者: 朱军 zhujun@fmmu.edu.cn E-mail:zhujun@fmmu.edu.cn

Internal arteriovenous fistula operation program for small vessels: a clinical study

  • Received:2015-04-27 Revised:2015-08-10 Online:2015-11-12 Published:2015-11-12

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摘要： 【摘要】目的探讨慢性肾功能不全患者前臂细小血管自体动静脉内瘘术的最佳手术方案。方法 按术前血管彩色多普勒检查结果，选择动、静脉直径均＜2.0mm，但≥1.5mm 的拟行前臂动静脉内瘘术的患者共224 例纳入本研究。术中根据血管条件选择端端吻合(21 例)、动静脉双吻合(14 例)、端侧吻合(110例)及改良端侧吻合(79 例)等四种手术方式；术后测定吻合口直径及监测成熟指标，直至瘘成熟或达12周。研究分析术式及吻合口直径与手术成功率及成熟率的相关性。结果端端吻合术式成功率57.1%，成熟率58.3%；动静脉双吻合术式成功率78.6%，成熟率63.6%；端侧吻合术式成功率80.9%，成熟率84.3%；改良端侧吻合术式成功率89.9%，成熟率94.4%。改良端侧吻合方式在手术成功率和成熟率上均明显优于端端吻合手术方式(P＜0.01)，和常规端侧吻合术式比较，手术成功率相比无明显差异(P＞0.05)，但成熟率有明显差异(P＜0.05)；10～15mm 吻合口直径在细小血管内瘘术中成功率和成熟率均较直径较小者高，数据存在统计学意义。结论细小血管动静脉内瘘术的最佳术式为改良端侧吻合，术中将吻合口直径扩大到10～15mm 有利于内瘘成功和成熟。

关键词: 动静脉内瘘术, 自体血管, 细小血管, 手术方案, 成功率

Abstract: 【Abstract】Objective To explore the best operation program for autologous internal arteriovenous fistula using forearm small vessels in patients with chronic renal insufficiency. Methods Two hundred and twentyfour patients intended to undergo an operation for internal arteriovenous fistula but with arteries and veins ≥ 1.5mm and ＜2.0mm in diameter from preoperative vascular color Doppler ultrasonography were enrolled in this study. According to the vascular conditions at operation, one of the 4 operation methods was selected: endto- end anastomosis (n=21), arteriovenous anastomosis (n=14), end-to-side anastomosis (n=110), and modified end-to-side anastomosis (n=79). The diameter of anastomotic stoma was measured and the maturation index was monitored until maturation of the fistula or 12 weeks after the operation. The correlation of operation type with anastomotic stoma diameter, operation success rate and maturation rate was studied and analyzed. Results The success rate and maturation rate were 57.1% and 58.3%, respectively for end-to-end anastomosis, 78.6% and 63.6%, respectively for arteriovenous anastomosis, 80.9% and 84.3%, respectively for end-to-side anastomosis, and 89.9% and 94.4%, respectively for modified end-to-side anastomosis. The success rate and maturation rate was higher in modified end- to- side anastomosis than in end- to-end anastomosis (P＜0.01). The success rate was similar (P＞0.05) but the maturation rate was different (P＞0.05) between modified endto- side anastomosis and routine end-to-side anastomosis. The success rate and maturation rate were significantly higher in internal fistula operation with anastomotic stoma of 10～15mm diameter than in the operation with anastomotic stoma of ＜10～15mm diameter. Conclusions Modified end- to-side anastomosis is the best operation type for internal arteriovenous fistula of small vessels. Enlarging the anastomotic stoma diameter to 10～15mm during operation favors success and maturation of the internal fistula.

Key words: operation for internal arteriovenous fistula, autologous vessel, small vessel, operation program, success rate