细小血管动静脉内瘘术方案选择的临床研究  

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

作　　者：张凡[1] 陶杰[2] 王涛[1] 吴晓波[2] 莫立稳[1] 程悦[1] 朱军[1] 

机构地区：[1]成都军区总医院肾脏科,成都610083 [2]成都军区总医院超声科,成都610083

出　　处：《中国血液净化》2015年第11期681-685,共5页Chinese Journal of Blood Purification

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。Objective To explore the best operation program for autologous intemal arteriovenous fistula using forearm small vessels in patients with chronic renal insufficiency. Methods Two hundred and twenty- four patients intended to undergo an operation for internal arteriovenous fistula but with arteries and veins i〉 1.5ram and 〈2.0ram 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： end- to-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. Re- suits 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 end- to-side anastomosis and routine end-to-side anastomosis. The success rate and maturation rate were signifi- cantly 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 diame- ter to 10- 15mm during operation favors success and maturation of the internal fist

关 键 词：动静脉内瘘术 自体血管 细小血管 手术方案 成功率 

分 类 号：R318.16[医药卫生—生物医学工程]