不同吻合术式及测定部位对自体动静脉内瘘术后超声流量评估的影响  

Influence of different anastomotic methods and checkpoints on ultrasonographic flow assessment after autogenous arteriovenous fistula

作　　者：马晓波[1] 陈秋馨 吉莉倩 蒋怡倩 朱羽佳[1] 陈秋月 周霄怡 杨振华[1] 陈晓农[1] Ma Xiaobo;Chen Qiuxin;Ji Liqian;Jiang Yiqian;Zhu Yujia;Chen Qiuyue;Zhou Xiaoyi;Yang Zhenhua;Chen Xiaonong(Department of Nephrology,Shanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《国际泌尿系统杂志》2022年第2期316-320,共5页International Journal of Urology and Nephrology

摘　　要：目的探讨不同吻合术式及测量部位对自体动静脉内瘘术后超声流量评估的影响。方法选取2017年12月1日至2018年6月1日在本院行首次自体动静脉内瘘手术的患者30例,按照不同吻合术式分为端端吻合组(10例)和端侧吻合组(20例)。收集患者一般资料,并使用彩色多普勒超声在患者首次内瘘穿刺前,测量计算肱动脉、桡动脉、自体内瘘血流量及相关血流参数。结果所有患者术后无狭窄、栓塞等并发症发生。两组术后的评估时间分别为(7.9±2.4)、(7.2±2.0)个月,差异无统计学意义(P>0.05)。端端吻合组患者术后的吻合口内径为(3.8±1.1)mm,头静脉直径为(4.7±1.0)mm,头静脉(内瘘)血流量为(524.7±116.1)mL/min;端侧吻合组患者术后的吻合口内径为(7.9±2.1)mm,头静脉直径为(5.2±1.1)mm,头静脉(内瘘)血流量为(877.2±442.3)mL/min,两者在吻合口内径及内瘘流量比较,差异有统计学意义(P<0.05),但两组内瘘直径及头静脉与桡动脉的血流量比较,差异均无统计学意义(均P>0.05)。肱动脉、桡动脉、头静脉血流量两两间都呈线性相关(P<0.05);吻合口大小与头静脉流量间呈线性相关(P=0.045)。结论自体动静脉内瘘端侧吻合较端端吻合术后血流量更好。若考虑自体动静脉内瘘术后血流量对心功能的影响,须适当限制吻合口大小,此时端端吻合术式可作为第一选择。建议通过多普勒超声直接测量头静脉流量来评判内瘘成熟情况,肱动脉流量可作为内瘘功能的监测指标。Objective To investigate the Influence of different anastomotic methods and checkpoints on ultrasonographic flow assessment after autogenous arteriovenous fistula.Methods Thirty patients who underwent the first autologous arteriovenous fistula surgery in our hospital from December 1,2017 to June 1,2018 were selected and divided into end-to-end anastomosis group(10 cases)and end-to-end anastomosis group(20 cases)according to different anastomosis methods.General data of the patients were collected,and color Doppler ultrasound was used to measure and calculate the blood flow and related blood flow parameters of the brachial artery,radial artery and autologous fistula before the first internal fistula puncture.Results There was no significantly difference of age,primary disease,rate of diabetes and time to maturity between the two groups(P>0.05).No postoperative complications such as stenosis and embolism occurred in all patients.The postoperative evaluation time of the two groups was(7.9±2.4)and(7.2±2.0)months,respectively,with no statistical significance(P>0.05).In end-to-end group,the diameter of anastomotic stoma and the blood flow of cephalic vein were(3.8±1.1)mm and(524.7±116.1)mL/min.Those in end-to-side group were(7.9±2.1)mm and(877.2±442.3)mL/min with the statistical difference(P<0.05).There was no significant difference in the diameter of internal fistula(P>0.05).There was no statistical significance in blood flow of cephalic vein and radial artery between the two groups(P>0.05),but there was statistical significance in blood flow of brachial-cephalic vein and brachial-radial artery between the two groups(P<0.05).There was a linear correlation between venous blood flow of brachial artery,radial artery and head(P<0.05).Conclusions There is no significant difference in maturation time and diameter of internal fistula between the two anastomoses of autogenous arteriovenous fistula.The blood flow is better after end-to-side anastomosis.Considering the influence of blood flow after autologous arteriovenou

关 键 词：动静脉瘘 超声检查 动静脉吻合 

分 类 号：R692.5[医药卫生—泌尿科学]