前臂贵要静脉不同转位方式建立动静脉内瘘  

Establishment of arteriovenous fistula by different transposition of forearm basilic vein

作　　者：叶祖扬[1] 尹友生[1] 毕慧欣[1] 欧俊[1] 潘罅 冷斌[1] 王函[1] YE Zuyang;YIN Yousheng;BI Huixin;OU Jun;PAN Xia;LENG Bin;WANG Han(Department of Nephropathy,Affiliated Hospital of Guilin Medical University,Guilin 541001,China)

机构地区：[1]桂林医学院附属医院肾内科

出　　处：《实用医学杂志》2019年第15期2438-2442,共5页The Journal of Practical Medicine

基　　金：广西壮族自治区自然科学基金项目（编号：2016GXNSFBA380057）;广西壮族自治区卫生和计划生育委员会科研项目（编号：Z20170813）

摘　　要：目的探讨前臂贵要静脉直桥式与U形转位方式建立动静脉内瘘通畅率及在血液透析中的应用情况。方法选择2015年3月至2018年6月在我院行贵要静脉转位内瘘患者38例,直桥式转位手术21例(A组),U形转位手术17例(B组)。观察两组手术成功率、内瘘成熟时间、血透流量、可穿刺长度、通畅率、平均使用时间、并发症等指标。对内瘘术后使用时间的影响进行多因素COX风险回归分析。结果两组手术成功率均为100%;A组术后1个月、6个月、1年、2年内瘘通畅率分别为100%、90.5%、76.2%、66.7%,B组分别为100%、88.2%、70.6%、29.4%(术后2年P <0.05);A组内瘘平均使用时间(24.1±11.4)个月,B组(16.8±7.5)个月,差异有统计学意义(P <0.05);A组内瘘穿刺长度(16.8±1.2)cm,B组(12.4±1.7)cm,差异有统计学意义(P <0.05);两组术后成熟时间、血透流量、并发症无明显差异。COX分析提示不同手术方式是影响患者贵要静脉转位内瘘远期使用的独立预后因素(P <0.05)。结论贵要静脉直桥式转位内瘘较U形转位内瘘平均使用时间更长,长远通畅率更高,是头静脉耗竭血液透析患者良好的替代通路。Objective To discuss the patency rate of forearm basilic vein transposition(FBVT)created bydirect transposition and looped transposition and its application in hemodialysis. Methods Thirty-eighty patients with FBVT from March 2015 to June 2018 were selected,21 of which underwent direct transposition(group A)and 17 looped transposition(group B). The successful rate of operation,maturation time,hemodialysis flow,puncture length,patency rate,mean patency period and complications were observed in the two groups.Multivariate COX risk regression analysis was performed for the effect of postoperative time on arteriovenous fistula.Results The success rate of operation in both groups was 100%. Patency rate of group A was 100%,90.5%,76.2%and 66.7%in1 month,6 months,1 year and 2 years,respectively and that in Group B was100%,88.2%,70.6% and 29.4%,respectively(2 years postoperatively P < 0.05). The mean patency period was(24.1 ± 11.4)months in group A and(16.8 ± 7.5)months in group B(P < 0.05). The puncture length of group A was(16.8 ±1.2)cm and that of group B(12.4 ± 1.7)cm(P < 0.05). There was no significant difference in maturity time,hemodialysis flow and complications between the two groups.COX analysis suggested that different surgical methods were independent prognostic factors affecting the long-term use of FBVT. Conclusions Forearm basilic vein direct transposition is a better alternative forhemodialysis patients with exhausted cephalic vein than the looped transposition,which has a longer use time and a higher long-term patency rate.

关 键 词：血液透析 血管通路 动静脉内瘘 贵要静脉 

分 类 号：R692.5[医药卫生—泌尿科学]