人工血管动静脉内瘘静脉端不同吻合方式的应用效果比较  

Clinical application analysis of different venous anastomosis methods for arteriovenous graft

作　　者：高伟烨[1] 郭丁花 张振野 朱智祺 刘佳鑫 Gao Weiye;Guo Dinghua;Zhang Zhenye;Zhu Zhiqi;Liu Jiaxin(Department of Vascular Surgery,Huizhou First Hospital,Huizhou 516001,China;Hemodialysis Room,The Third People's Hospital of Huizhou,Huizhou 516002,China;Department of Nephrology,Huizhou First Hospital,Huizhou 516001,China;Department of Ultrasound,Huizhou First Hospital,Huizhou 516001,China)

机构地区：[1]惠州市第一人民医院血管外科,广东惠州516001 [2]惠州市第三人民医院血透室,广东惠州516002 [3]惠州市第一人民医院肾内科,广东惠州516001 [4]惠州市第一人民医院超声科,广东惠州516001

出　　处：《中国血管外科杂志（电子版）》2023年第2期141-144,148,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：惠州市科技计划科研项目(2022CZ010140)。

摘　　要：目的 比较人工血管动静脉内瘘静脉端不同吻合方式的临床应用效果及预后。方法 回顾性分析2021年1月至2021年12月惠州市第一人民医院行人工血管动静脉内瘘成形术的96例患者临床资料。根据人工血管静脉端吻合方式,分为端端吻合组(49例)和端侧吻合组(47例),比较两组术后相关临床指标和并发症发生情况。结果 术后6周,端端吻合组的内瘘血流量高于端侧吻合组[(697±188) ml/min vs (601±154) ml/min],差异有统计学意义(P=0.014)。术后6个月,端端吻合组和端侧吻合组的初级通畅率(89.80%vs 89.36%)、辅助初级通畅率(93.88%vs 93.61%)、次级通畅率(97.95%vs 97.87%)和尿素清除指数(1.28±0.22 vs 1.31±0.17)差异均无统计学意义(P>0.05)。术后12个月,端端吻合组的初级通畅率(65.31%vs 55.31%)和次级通畅率(91.83%vs 82.98%)显著高于端侧吻合组(P<0.05),辅助初级通畅率(79.59%vs 74.47%)和尿素清除指数(1.33±0.16 vs 1.35±0.13)差异无统计学意义(P>0.05)。端端吻合组并发症发生率为46.93%,端侧吻合组为65.96%,差异有统计学意义(P=0.002)。结论 人工血管动静脉内瘘采用端端吻合方式时,内瘘血流量更大、通畅率更高、术后并发症发生率更低,临床应用效果及预后更佳。Objective To compare the clinical effect and prognosis of different venous anastomosis methods of arteriovenous graft.Methods The clinical data of 96 patients who underwent arteriovenous graft in Huizhou First Hospital from January 2021 to December 2021 were analyzed retrospectively.According to the venous anastomosis method,they were divided into end-to-end anastomosis group(49 cases)and end-to-side anastomosis group(47 cases),and the relevant clinical indicators and complications after operation were compared between the two groups.Results At six weeks after operation,the fistula blood flow in the end-to-end anastomosis group was higher than that in the end-to-side anastomosis group(697±188 ml/min vs 601±154 ml/min),and the difference was statistically significant(P=0.014).At Six months after operation,the primary patency rate(89.80%vs 89.36%),assisted primary patency rate(93.88%vs 93.61%),secondary patency rate(97.95%vs 97.87%)and urea clearance index(1.28±0.22 vs 1.31±0.17)in the end-to-end anastomosis group and the end-to-side anastomosis group were not statistically different(P>0.05).At 12 months after operation,the primary patency rate(65.31%vs 55.31%)and secondary patency rate(91.83%vs 82.98%)of the end-to-end anastomosis group were significantly higher than those of the end-to-side anastomosis group(P<0.05).The assisted primary patency rate(79.59%vs 74.47%)and urea clearance index(1.33±0.16 vs 1.35±0.13)of the end-to-end anastomosis group had no significant difference with end-to-side anastomosis group(P>0.05).The incidence of complications in the end-to-end anastomosis group and end-to-side anastomosis group was 46.93%and 65.96%respectively,the difference was statistically significant(P=0.002).Conclusion The end-to-end anastomosis of arteriovenous graft can lead to greater blood flow,higher patency rate,less postoperative complications,and the clinical application effect and prognosis are better.

关 键 词：血液透析 人工血管动静脉内瘘 吻合术 通畅率 

分 类 号：R654.3[医药卫生—外科学]