使用自体血管移植修复失功自体动静脉内瘘的临床疗效分析  

Analysis of Clinical Effect of Repairing Failed Autologous Arteriovenous Fistula with Autologous Blood Vessel Transplantation

作　　者：葛健君 叶锋 兰行远[1] 周辉 宋庆青 陆清声 GE Jianjun;YE Feng;LAN Xingyuan;ZHOU Hui;SONG Qingqing;LU Qingsheng(Department of Vascular Surgery,the Second Hospital of Nanping City,Nanping,Fujian Province,354200 China;Department of Vascular Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai,200000 China)

机构地区：[1]福建省南平市第二医院血管外科,福建南平354200 [2]海军军医大学附属长海医院血管外科,上海200000

出　　处：《中外医疗》2022年第29期5-9,共5页China & Foreign Medical Treatment

基　　金：南平市科学技术局自然科学基金联合资助项目(2019J37)。

摘　　要：目的探讨使用自体血管移植修复失功自体动静脉内瘘的临床疗效。方法方便选取福建省南平市第二医院2019年9月—2021年2月收治的55例上肢自体动静脉内瘘失功患者为研究对象,实施自体血管移植修复治疗,观察患者的治疗恢复情况。结果自体动静脉内瘘失功患者接受自体血管移植修复治疗期间,一次性吻合成功率为100%,术后6、12个月的手术部位通畅率分别为92.73%和81.82%,差异无统计学意义(χ^(2)=2.946,P>0.05),术后6、12个月的并发症发生率为3.64%和9.84%,差异无统计学意义(χ^(2)=1.213,P>0.05)。与自体血管移植修复前相比,修复后的脂蛋白相关磷脂酶A2(Lp-PLA2)水平[(1429.54±78.14)ng/mL vs(1574.59±135.33)ng/mL]、中性粒细胞计数和淋巴细胞计数比值(NLR)水平[(3.49±0.76)vs(4.41±0.82)]以及血红蛋白(Hb)水平[(92.71±9.22)g/L vs(104.85±10.41)g/L]相对更低,差异有统计学意义(t=6.884、6.103、6.474,P<0.05)。结论在失功自体动静脉内瘘的临床治疗中,采用自体血管移植手术进行修复,可以有效重建动静脉内瘘,保障血管通路的通畅,为血液透析治疗安全、顺利的进行提供支持。Objective To investigate the clinical efficacy of autologous vascular grafting in repairing failed autologous arteriovenous fistulas.Methods Fifty-five patients with upper extremity autologous arteriovenous fistula failure who were admitted to the Second Hospital of Nanping City,Fujian Province from September 2019 to February 2021 were conveniently selected as the research subjects.Autologous vascular graft repair was performed,and the patient′s recov⁃ery was observed.Results During the repair of autologous arteriovenous fistula,the one-time anastomosis success rate was 100%,and the patency rates of the surgical site were 92.73%and 81.82%at 6 months and 12 months after opera⁃tion,respectively,and the difference was not statistically significant(χ^(2)=2.946,P>0.05).The complication rates at 6 months and 12 months after operation were 3.64%and 9.84%,and there was no statistically significant difference(χ^(2)=1.213,P>0.05).Compared with before autologous vascular graft repair,the level of lipoprotein-associated phospholi⁃pase A2(Lp-PLA2)[(1429.54±78.14)ng/mL vs(1574.59±135.33)ng/mL],neutrophil count and lymphocyte count ra⁃tio(NLR)level[(3.49±0.76)vs(4.41±0.82)],and hemoglobin(Hb)level[(92.71±9.22)g/L vs(104.85±10.41)g/L]was relatively lower after autologous vascular graft repair,and the difference was statistically significant(t=6.884,6.103,6.474,P<0.05).Conclusion In the clinical treatment of failed autologous arteriovenous fistulas,autologous vascular transplantation for repair can effectively reconstruct arteriovenous fistulas,ensure the patency of vascular access,and provide support for the safe and smooth progress of hemodialysis treatment.

关 键 词：自体血管移植 修复 失功 自体动静脉内瘘 临床疗效 

分 类 号：R5[医药卫生—内科学]