上臂贵要静脉转位内瘘及前臂人工血管内瘘在血液透析患者应用效果的比较  

Comparison of efficacy of brachio-basilic transposition arteriovenous fistula and forearm loop arteriovenous graft for hemodialysis patients

作　　者：缪鹏[1] 谭正力[1] 田然[1] 姚辰亮 蔡志文 郁正亚[1] Miao Peng;Tan Zhengli;Tian Ran;Yao Chenliang;Cai Zhiwen;Yu Zhengya(Department of Vascular Surgery,Beijing Tongren Hospital,Capital Medical University,Department of Vascular Surgery of Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院血管外科首都医科大学血管外科学系,北京100730

出　　处：《中国血管外科杂志（电子版）》2023年第2期136-140,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的 比较上臂贵要静脉转位内瘘(brachio-basilic transposition arteriovenous fistula,BBTAVF)及前臂人工血管内瘘在血液透析患者的应用效果。方法 回顾性分析首都医科大学附属北京同仁医院2017年1月至2020年1月行BBT-AVF患者(45例)及以贵要静脉为流出道建立人工血管(brachio-basilic arteriovenous graft,BAVG)患者(64例)的临床资料,比较术后36个月的生存率、通路通畅率及手术相关并发症等结果。结果 BBT-AVF组及BAVG组在术后12、24、36个月生存率分别为100%、95.6%、95.6%和98.4%、93.8%、81.3%,差异有统计学意义(P=0.032);术后12、24、36个月的一期通畅率分别为83.4%、70.1%、63.1%和46.9%、14.9%、5.0%,二期通畅率分别为95.2%、89.6%、86.1%和84.4%、65.0%、44.5%,差异有统计学意义(P<0.001)。两组患者在随访期间内30 d急性血栓、假性动脉瘤、中心静脉狭窄、感染及窃血综合征发生率比较差异均无统计学意义(P>0.05)。BBT-AVF组再干预次数低于BAVG组。结论 BBT-AVF术后通畅率优于BAVG,再干预频次低,但由于手术复杂,应依据临床情况个体化选择治疗方案。Objective To investigate the efficacy of brachio-basilic transposition arteriovenous fistula(BBT-AVF)and forearm loop arteriovenous graft for hemodialysis patients.Methods The clinical data of patients who received BBT-AVF(45 cases)and brachio-basilic arteriovenous graft(BAVG,64 cases)at Beijing Tongren Hospital,Capital Medical University from January 2017 to January 2020 were analyzed retrospectively.Survival rate,patency and complications in 36 months after operation between the two groups were compared.Results The survival rate for BBT-AVF group and BAVG group was 100%,95.6%,95.6%and 98.4%,93.8%,81.3%,which showed statistically significant(P=0.032).Primary patency for BBT-AVF and BAVG was 83.4%and 46.9%at 12 months,70.1%and 14.9%at 24 months,and 63.1%and 5.0%at 36 months,respectively.Secondary patency for BBT-AVF and BAVG was 95.2%and 84.4%at 12 months,89.6%and 65.0%at 24 months,and 86.1%and 44.5%at 36 months,respectively,and the differences were statistically significant(P<0.001).Perioperative complications such as the incidence of acute thrombosis within 30 days postoperatively,pseudoaneurysm,central venous stenosis,infection and steal syndrome showed no statistically differences between the two groups(P>0.05).The rate of re-intervention was lower in BBT-AVF compared to BAVG.Conclusion BBT-AVF showes higher patency and lower re-intervention rate compared to BAVG.While the procedure of BBT-AVF is complicated,individual design for therapy should be considered for different patients.

关 键 词：血液透析 贵要静脉 自体动静脉内瘘 人工血管动静脉瘘内瘘 通畅率 

分 类 号：R692.5[医药卫生—泌尿科学] R654.3[医药卫生—外科学]