两种方式吻合动静脉内瘘的比较研究  

Comparative study of two methods establishing artery-vein internal fistula for hemodialysis

作　　者：管延蒙[1] 楼季庄[1] 杨蓊勃[2] 周玥[1] 袁红波[1] 杨江生[1] 黄宁昌[1] 陈晓霞[1] 陈建军[1] 

机构地区：[1]南京医科大学附属南京医院,南京市第一医院血液净化中心,南京210006 [2]南京医科大学附属南京医院,南京市第一医院骨科,南京210006

出　　处：《临床肾脏病杂志》2012年第11期501-503,共3页Journal Of Clinical Nephrology

摘　　要：目的比较新发终末期肾脏病（ESRD）患者应用钛轮钉机械吻合与手工缝线吻合动静脉内瘘（AVF）的使用寿命、影响因素及术后并发症状况，总结两种吻合内瘘方法的优缺点，旨在为患者提供合适的吻合方式及内瘘保护方式。方法回顾性分析我中心于2009年4月至2010年4月之间的所有新发ESRD需行血液透析患者47例，其中27例采用钛轮钉吻合器行桡动脉一头静脉内瘘吻合，2（）例采用传统血管端端吻合，随访24月，比较两组的内瘘通畅时间，并分别计算6、12及24个月的内瘘通畅率，并分析影响内瘘通畅时间的相关因素及其随访24月的长期并发症状况。结果随访24月钛轮钉组内瘘通畅时间为（19．85士6．876）个月，手工缝线组为（22．95士3．268）个月。钛轮钉组内瘘6、12、24个月通畅率分别为92．6％、81．5％、66．7％，而手工吻合组为100％、95％、9（）％，原发病、低蛋白血症、房颤及吸烟史在一定程度上影响AVF的使用寿命，尤其是应用钛轮钉吻合AVF的患者。手工缝线组在心衰、静脉过度曲张及假性动脉瘤等并发症方面较钛轮钉组患者多。结论虽然钛轮钉机械吻合AVF在手术方法上简单容易操作，但对患者自身血管要求较高，手工缝线吻合组内瘘通畅时间明显比钛轮钉组延长，但其长期并发症发生率较钛轮钉组高。Objective This study compared titanium ring-pin stapler and han＆sutures on arter- y-vein internal fistula（AVF） in ESRD patients including the maintenance time of the internal fistula and the successful rate. The aim of the study was to provide proper method for AVF for patients. Methods In 47 ESRD patients, AVF were either titanium ring-pin stapler（27 cases）or interrupted nylon sutures（20 cases）. The maintenance time of the AVF and the successful rate of six months, twelve months and twenty-four months were observed. Results Followed twenty-four months, the maintenance time of the AVF of two groups were 19. 85~6. 876 months and 22. 95-[z3. 268 months. The Unobstructed rate of titanium ring-pin stapler group were 92. 6% ,81.50//00,66. 7%, while the oth- er group were 100% ,95~, 900/00. The primary disease, hypoproteinemia, fibrillation atrial, smoking maybe affect the maintenance time, especial in the titanium ring-pin stapler group. However, the hand-sutures group had more complications in the followed two years. Conclusions It is convenient to establish AVF with titanium ring-pin stapler while it has more problems for blood vessels. The main- tenance time of the AVF of hand-sutures group was more longer, while the future complications oc- curred more.

关 键 词：钛轮钉 动静脉内瘘 终末期.肾脏病 缝线吻合 

分 类 号：R543[医药卫生—心血管疾病]