中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 1032-1036.doi: 10.3969/j.issn.1671-4091.2025.12.014

• 血管通路 • 上一篇    下一篇

吻合角度对动静脉内瘘手术后内瘘血流量的影响

周 翠   庄 峰    仙淑丽    唐新妹   王应灯   

  1. 201411 上海，1上海市奉贤区奉城医院肾内科
    200011 上海，2上海交通大学医学院附属第九人民医院肾内科
  • 收稿日期:2025-05-06 修回日期:2025-08-29 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 王应灯 E-mail:wangyd7001@sina.com
  • 基金资助:
    上海交通大学医学院附属第九人民医院临加课题(JYLJ202116)

Impact of anastomotic angle on blood flow volume in arteriovenous fistulas after surgery

ZHOU Cui, ZHUANG Feng, XIAN Shu-li, TANG Xin-mei, WANG Ying-deng   

  1. Department of Nephrology, Shanghai Fengcheng Hospital, Fengxian District, Shanghai 201411, China; 2Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
  • Received:2025-05-06 Revised:2025-08-29 Online:2025-12-12 Published:2025-12-12
  • Contact: 200011 上海，2上海交通大学医学院附属第九人民医院肾内科 E-mail:wangyd7001@sina.com

摘要： 目的 观察和比较桡动脉-头静脉不同吻合角度对自体动静脉内瘘(arteriovenous fistula,AVF)手术后早期肱动脉血流量的影响。 方法 选取2022年10月─2024年12月在上海交通大学医学院附属第九人民医院肾脏内科第一次实施AVF成型术的终末期肾病(end-stage renal disease,ESRD)患者为研究对象，采用随机数表法将患者分为30°吻合角组(组1)和45°吻合角组(组2)。手术后4周及8周，通过彩色多普勒超声检测2组患者的吻合口近端流入道桡动脉内径、吻合口近端流入道桡动脉收缩期峰值速度、肱动脉血流量、内径、峰值流速及吻合口内径等参数，并进行组间比较。 结果 手术后4周及8周，2组患者的吻合口近端流入道桡动脉内径(4周：t=0.554，P=0.294；8周：t=-0.086，P=0.466)、吻合口近端流入道桡动脉收缩期峰值速度(4周：Z=-0.845，P=0.412；8周：t=-0.340，P =0.369)、肱动脉血流量(4周：t =-778，P =0.450；8周：t =-553，P =0.296)、肱动脉内径(4周：Z =-0.956，P =0.339；8周：t=-1.579，P =0.066)、肱动脉峰值流速(4周：t=1.155，P=0.272；8周：t=0.424，P =0.339)及吻合口内径(4周：Z=   -0.785，P=0.432；8周：Z=-1.574，P=0.115)差异均无统计学意义。 结论 在桡动脉-头静脉AVF成形术中，30°与45°吻合角度对手术后早期肱动脉血流量的影响无显著差异。为提高AVF手术后肱动脉流量，需综合考虑血管条件、手术技术、缝合技术及术后管理等因素。

关键词: 动静脉内瘘, 吻合角度, 肱动脉血流量, 血液透析

Abstract: Objective  To observe the effects of different anastomotic angles (30° vs. 45°) between radial artery and cephalic vein on early postoperative brachial artery blood flow in autogenous arteriovenous fistulas (AVFs).  Methods  A prospective, randomized and controlled trial was conducted for patients with end-stage renal disease (ESRD) undergoing first AVF creation at the Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from October 2022 to December 2024. The participants were randomized into two groups using a random number table: group 1 (30° anastomotic angle) and group 2 (45° anastomotic angle). After the surgery for 4 and 8 weeks, color Doppler ultrasound was used to measure internal diameter of the proximal inflow radial artery, peak systolic velocity (PSV) of the proximal inflow radial artery, blood flow, internal diameter and peak velocity of the brachial artery, and the anastomotic diameter. These parameters were compared between the two groups.  Results  After the surgery for 4 and 8 weeks, no statistically significant differences were observed between the two groups in: proximal inflow radial artery diameter (4 weeks: 3.49±0.83 mm vs. 3.27±0.70 mm, t=0.554, P=0.294; 8 weeks: 3.89±0.30 mm vs. 3.93±0.90 mm, t=-0.086, P=0.466), radial artery PSV [4 weeks: 99.00 (89.00, 104.25) cm/s vs. 99.00 (89.15, 101.75) cm/s, Z=-0.845, P=0.412; 8 weeks: 110.31±18.12 cm/s vs. 113.56±20.01 cm/s, t=-0.340, P=0.369), brachial artery blood flow (4 weeks: 681.75±251.35 mL/min vs. 593.63±198.85 mL/min, t=-0.778, P=0.450; 8 weeks: 752±161.74 mL/min vs. 827.38±350.04 mL/min, t=-0.553, P=0.296), brachial artery diameter [4 weeks: 4.80 (4.55, 5.05) mm vs. 5.40 (4.58, 6.00) mm, Z=-0.956, P= 0.339; 8 weeks: 4.85±0.47 mm vs. 5.33±0.70 mm, t=-1.579, P=0.066], brachial artery peak velocity (4 weeks: 125.03±26.51 cm/s vs. 112.54±15.23 cm/s, t=1.155, P=0.272; 8 weeks: 127.99±23.78 cm/s vs. 123.21±21.18 cm/s, t=0.424, P=0.339), anastomotic diameter [4 weeks: 4.00 (3.93, 4.00) mm vs. 4.00 (3.33, 4.00) mm, Z=-0.785, P=0.432; 8 weeks: 4.00 (4.00, 4.18) mm vs. 4.00 (3.73, 4.00) mm, Z=-1.574, P=0.115].   Conclusion  In radial artery-cephalic vein AVF creation, 30° and 45° anastomotic angles had no significant difference in early postoperative brachial artery blood flow. To increase the postoperative brachial artery flow, the factors of vascular condition, surgical technique, suture method, and postoperative management must be comprehensively considered.

Key words: Arteriovenous fistula, Anastomotic angle, Brachial artery blood flow, Hemodialysis

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