中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (11): 956-963.doi: 10.3969/j.issn.1671-4091.2025.11.017

• 血管通路 • 上一篇    下一篇

肱动脉-贵要静脉动静脉内瘘与上肢移植物动静脉内瘘在血管通路中的临床效果比较：系统回顾与荟萃分析

李 丹  杜宗华  代凤鸣  龙 青  汪 伟   

  1. 445000 湖北，1恩施土家族苗族自治州中心医院肾病内科
    445000 湖北，2湖北民族大学附属民大医院手足外科
  • 收稿日期:2025-02-24 修回日期:2025-09-01 出版日期:2025-11-12 发布日期:2025-11-12
  • 通讯作者: 汪伟 E-mail:wm160000@163.com

Brachiobasilic fistula vs. upper arm arteriovenous graft for dialysis access: a systematic review and meta-analysis

LI Dan  DU Zong-hua  DAI Feng-ming  LONG Qing  WANG Wei   

  1. Department of Nephrology, Enshi Prefecture Central Hospital, Hubei 445000, China; 2Department of Hand and Foot Surgery, Minda Hospital Affiliated to Hubei Minzu University, Hubei, 445000, China
  • Received:2025-02-24 Revised:2025-09-01 Online:2025-11-12 Published:2025-11-12
  • Contact: 445000 湖北，2湖北民族大学附属民大医院手足外科 E-mail:wm160000@163.com

摘要： 目的 比较肱动脉-贵要静脉动静脉内瘘(brachiobasilic arteriovenous fistula,BBAVF)与上肢移植物动静脉内瘘(arteriovenous graft,AVG)在血管通路中的通畅率及并发症差异，为优化三级血管通路选择提供证据。 方法 检索PubMed、Cochrane图书馆、Embase和Science Direct数据库，并手动筛选参考文献。使用纽卡斯尔-渥太华量表评估研究质量，并对提取数据进行荟萃分析，比较BBAVF组与AVG组 在1年、2年通畅率及并发症发生率上的差异。 结果 共纳入24篇文献。BBAVF组在1年的初级(OR=1.837,95% CI:1.332～2.533,P＜0.001)、辅助(OR=2.242，95%CI:1.439～3.494,P＜0.001)、次级(OR=1.465,95%CI:1.029～2.088,P=0.034)及累积(OR=1.739,95%CI：1.052～2.875,P=0.031)通畅率及2年的初级(OR=2.140,95% CI:1.469～3.118，P＜0.001)、辅助(OR=2.529,95% CI:1.789～3.575,P＜0.001)、次级(OR=1.748,95%CI:1.371～2.229，P＜0.001)及累积(OR=2.002,95% CI:1.234～3.249,P=0.005)通畅率方面均优于AVG组。并发症方面，AVG组的手术后感染(OR=0.207，95% CI：0.128～0.334，P＜0.001)、血栓发生(OR=0.285，95% CI：0.207～0.392，P＜0.001)和盗血综合征发生(OR=0.628，95% CI：0.396～0.996，P=0.048)的风险更高，BBAVF组的出血风险更高(OR=2.725，95% CI：1.549～4.793，P=0.001)。2组在动脉瘤(OR=0.849，95% CI：0.457～1.577，P=0.605)、吻合口狭窄(OR=0.471，95% CI：0.133～1.666，P=0.243)及总并发症发生率(OR=0.924，95% CI：0.502～1.701，P=0.799)上比较无显著差异。 结论 BBAVF在通畅率及感染、血栓控制上更优，推荐为血管条件良好患者的首选；AVG适用于紧急透析或血管条件较差者。

关键词: 终末期肾病, 透析, 血管通路, 贵要静脉动静脉内瘘, 移植物动静脉内瘘

Abstract: Objective  To compare the patency rates and complications of brachiobasilic arteriovenous fistula (BBAVF) and upper extremity arteriovenous graft (AVG) as vascular access options, providing evidence to optimize tertiary vascular access selection.  Methods  We searched PubMed, the Cochrane Library, Embase, and ScienceDirect databases and manually screened the references. The Newcastle-Ottawa Scale was used to assess study quality. Data were extracted and a meta-analysis was performed to compare the one- and two-year patency rates and complication rates between BBAVF and AVG.  Results  A total of 24 studies were included. The BBAVF group demonstrated superior outcomes compared to the AVG group in terms of one-year primary (OR=1.837, 95% CI: 1.332～2.533, P＜0.001), assisted (OR=2.242, 95% CI: 1.439～3.494, P＜0.001), secondary (OR=1.465, 95% CI: 1.029～2.088, P=0.034), and cumulative patency rates (OR=1.739, 95% CI: 1.052～2.875, P=0.031). The BBAVF group also had better two-year primary (OR=2.140, 95% CI: 1.469～3.118, P＜0.001), assisted (OR=2.529, 95% CI: 1.789～3.575, P＜0.001), secondary (OR=1.748, 95% CI: 1.371～2.229, P＜0.001), and cumulative patency rates (OR=2.002, 95% CI: 1.234～3.249, P=0.005). Regarding complications, the AVG group had a higher risk of postoperative infection (OR=0.207,  95% CI: 0.128～0.334, P＜0.001), thrombosis (OR=0.285, 95% CI: 0.207～0.392, P＜0.001), and steal syndrome (OR=0.628, 95% CI: 0.396～0.996, P=0.048), while the BBAVF group had a higher risk of bleeding (OR=2.725, 95% CI: 1.549～4.793, P=0.001). There were no significant differences between the two groups in the incidence of aneurysm (OR=0.849, 95% CI: 0.457～1.577, P=0.605), anastomotic stenosis (OR=0.471, 95% CI: 0.133～1.666, P=0.243), or overall complications (OR=0.924, 95% CI: 0.502～1.701, P=0.799).  Conclusion  BBAVF is superior in terms of patency rate and control of infection and thrombosis, and is recommended as the first choice for patients with good vascular conditions. AVG is more suitable for urgent dialysis or for patients with poor vascular conditions.

Key words: End-stage renal disease, Dialysis, Vascular access, Brachiobasilic arteriovenous fistula, Arteriovenous graft

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