延长吻合口长度的侧侧吻合对前臂远端桡动脉-头静脉内瘘成熟的影响  

Effect of side-to-side anastomosis with extended anastomotic length on the maturation of radiocephalic arteriovenous fistula in the distal forearm

作　　者：安传国 焦自钊 李维娜 付海霞 范晴 李凤楼 An Chuanguo;Jiao Zizhao;Li Weina;Fu Haixia;Fan Qing;Li Fenglou(Department of General Surgery,the People’s Hospital of Rizhao,Jining Medical College,Rizhao 276826,China;不详)

机构地区：[1]济宁医学院附属日照市人民医院普外科,日照276826 [2]济宁医学院附属日照市人民医院血液净化科,日照276826

出　　处：《国际移植与血液净化杂志》2022年第4期1-5,共5页International Journal of Transplantation and Hemopurification

基　　金：济宁医学院教师科研扶持基金(JYFC2019FKJ221);日照市科技研发专项基金(KJYF2019289)。

摘　　要：目的探讨应用延长吻合口长度的侧侧吻合构建前臂远端桡动脉-头静脉内瘘(radiocephalic arteriovenous fistula,RC-AVF)对内瘘成熟的影响。方法选取2018年7月至2019年5月期间于我院血液净化科首次实施前臂远端RC-AVF手术的患者为研究对象,其中48例RC-AVF患者于2018年7月至2018年12月应用头静脉端与桡动脉侧的端侧吻合,吻合口常规长度为6.0~8.0 mm(ETS组);44例RC-AVF患者于2019年1月至2019年5月应用头静脉侧与桡动脉侧的侧侧吻合并结扎头静脉远心端,吻合口延长长度为10.0~12.0 mm(STS组)。术后随访12周,应用临床血管检查结合内瘘泵控血流量评估两组患者内瘘的临床成熟状况,应用彩色多普勒超声血管检查评估两组患者内瘘的影像学成熟状况。结果两组患者基线临床资料比较差异无统计学意义。术后第4周、8周、12周,STS组临床内瘘成熟率高于ETS组(P<0.05);术后第4周、8周、12周,STS组影像学内瘘成熟率亦高于ETS组(P<0.05)。重复测量数据的方差分析显示,STS组内瘘术后桡动脉内径、头静脉内径及自然血流量均大于ETS组(P<0.05)。结论与应用端侧吻合并常规吻合口长度比较,应用侧侧吻合并适当延长吻合口长度构建RC-AVF能够促进内瘘成熟并提高内瘘成熟率。Objective To investigate the effect of side-to-side anastomosis with prolonged anastomotic length on the maturation of radiocephalic arteriovenous fistula(RC-AVF)in the distal forearm.Methods Patients undergone the first distal forearm RC-AVF creation in the Department of Blood Purification from July 2018 to May 2019 were enrolled in this study.End-to-side with conventional length(6.0 to 8.0 mm)of RC-AVF anastomosis was used in 48 patients from July 2018 to December 2018(ETS group),and side-to-side with extended length(10.0 to 12.0 mm)of RC-AVF anastomosis was applied in 44 patients from January 2019 to May 2019(STS group).During the 12 weeks of postoperative follow-up,clinical vascular examination and fistula’s pump controlled blood flow were used to evaluate the clinical mature status of the fistula,and color doppler angiography was applied to estimate the imaging mature status of the fistula.Results There was no significant difference in the general clinical data between the two groups.At the 4th,8th and 12th week after the construction of the fistula,the clinical fistula mature rates of the STS group were higher than those of the ETS group(P<0.05).At the 4th,8th and 12th week after the construction of the fistula,the imaging fistula mature rates of the STS group were also higher than those of ETS group(P<0.05).The variance analysis of repeated measurement data showed that the radial artery diameter,cephalic vein diameter and natural blood flow of the fistula in the STS group were higher than those of the ETS group(P<0.05).Conclusion Compared with end-to-side with conventional length anastomosis,applying side-to-side with appropriately extended length anastomosis to construct the RC-AVF could promote the maturation and improve the maturity rate of the fistula.

关 键 词：动静脉内瘘 侧侧吻合 端侧吻合 吻合口长度 桡动脉 头静脉 

分 类 号：R654.3[医药卫生—外科学]