皮内缝扎法在动静脉内瘘术静脉属支及交通支结扎中的应用  

The utilization of intradermic transfixion to ligature attributive and communicating vein branches in the surgery of arteriovenous fistula

作　　者：王彦斌[1] 张辉[1] 孟伟[1] 韩国林[1] 相华[1] 常帅[1] 

机构地区：[1]解放军474医院肾病科,乌鲁木齐830013

出　　处：《中国血液净化》2012年第10期533-536,共4页Chinese Journal of Blood Purification

摘　　要：目的探索动静脉内瘘术中静脉属支及交通支结扎的最佳手术方法。方法本组98例,内瘘术式均采用前臂桡动脉和头静脉端端吻合的标准内瘘,术前常规进行桡动脉及头静脉B超检查,明确头静脉所有属支及伴行静脉交通支情况并做好标记,按所需结扎的静脉支数随机分为皮内缝扎组(观察组,n=52)和切开结扎组(对照组,n=46),对比2组间手术用时、手术并发症、术后静脉结扎术区肿胀程度、术后静脉结扎术区疼痛程度、术后感染比例、术后3月静脉结扎有效率、术后3月静脉结扎术区硬结形成比例。结果 观察组手术用时少于对照组,而且所需结扎支数越多,用时差异越明显(F=45.586,P=0.000),术后静脉结扎术区疼痛程度轻于对照组(Z=2.289,P=0.022),术后3月静脉结扎术区硬结比例及大小低于对照组(X2=4.176,P=0.041);观察组与对照组术后静脉结扎术区肿胀程度差异虽未达统计学标准但极度接近(Z=1.904,P=0.057);2组间手术并发症、术后感染比例、术后3月静脉结扎有效率无明显差异。结论皮内缝扎法具有手术时间短、术后疼痛及肿胀程度轻、硬结形成比例少等优点,而且结扎效果可靠、并发症少、不留瘢痕,在动静脉内瘘术静脉属支及交通支的结扎中优于切开结扎法。Objective To search for the best ligature technique of attributive and communicating vein branches in surgery of arteriovenous fistula （AVF）. Method The clinical data consisted of 98 patients who received AVF of radial artery and cephalic vein by end-to-end anastomosis. The course of radial artery and cephalic vein was detected by ultrasonography before surgery in order to identify the attributive and communicating branches of cephalic vein. The patients were randomly divided into two groups according to the number of vein branches needed to be ligatured; group I received intradermic transfixion （n=52） and group lI received dissection and ligation （n=46） to ligature the vein branches. The items including operation time, complication of surgery, degree of tumescence, degree of pain, ratio of infection, efficiency of ligation, and ratio of induration were compared between the two groups. Results The operation time of group I was shorter than that of group lI, and this difference enlarged as the number of ligatured vein branches increased （F=45.586, P=0.000）. The degree of pain was less severe in group I than in group II （Z=2.289, P=0.022）. The ratio and size of induration were less in group I than in group II （x2=4.176, P=0.041）. The degree of tumescence showed no statistical difference between the two groups, but approximated to the statistically signifi- cant area （Z=1.904, P=0.057）. There were no statistical differences between the two groups regarding sur- gery complications, infection ratio and ligation efficiency. Conclusion The intradermic transfixion is better than dissection and ligation, and should be preferably used in the ligation of attributive and communicating vein branches in AVF surgery.

关 键 词：血液透析 动静脉瘘 外科手术 微创性 侧支循环 

分 类 号：R318.16[医药卫生—生物医学工程]