超声引导下静脉属支结扎治疗动静脉内瘘功能不良的疗效  

Ultrasound⁃guided ligation of venous branches in treatment of arteriovenous

作　　者：詹申 温静 张丽红[1] 崔锐[1] 侯西彬[1] 郭姗姗 王玉柱[1] fistula dysfunction ZHAN Shen;WEN Jing;ZHANG Lihong;CUI Rui;HOU Xibin;GUO Shanshan;WANG Yuzhu(Department of Nephrology,Beijing Haidian Hospital,Beijing Haidian Section of Peking University Third Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院北京大学第三医院海淀院区肾内科,北京100080

出　　处：《肾脏病与透析肾移植杂志》2023年第4期336-341,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨超声引导下静脉属支结扎法(UGLVB)在动静脉内瘘功能不良的血液透析患者中的疗效和安全性。方法:回顾性分析2018-01-01~2022-09-30在北京市海淀医院肾脏内科行静脉属支结扎患者的一般临床资料、手术方案、术后并发症等。将患者分为传统切开结扎术式组(切开结扎组)和UGLVB组,比较两组基线资料、手术成功率、手术时间、伤口愈合时间及并发症、内瘘通畅情况、治疗费用等情况。结果:入选共44例患者,UGLVB组19例、传统切开结扎术式组25例。静脉属支结扎最常见的原因是主干流量不足(84.09%),结扎的静脉属支最多见的是头静脉背侧属支(54.55%)。两组在年龄、性别、基础肾脏病、共患疾病、透析龄、内瘘龄、内瘘启用时间、静脉属支结扎原因和部位上差异均无统计学意义。手术均获成功,UGLVB组伤口愈合时间低于切开结扎组(2.42±0.51 d vs 12.72±1.49 d,t=-32.256,P=0.000)。并发症方面,切开结扎组有1例出现切口愈合不良,UGLVB组2例、切开结扎组1例出现伤口局部少量渗血,切开结扎组有1例出现神经损伤。两组均未出现严重出血、感染等严重不良事件。结论:UGLVB与传统切开结扎术式在静脉属支结扎术的成功率和并发症方面无明显差异,在减少手术创伤和伤口愈合方面优于传统术式,是一种安全、有效、微创的临床操作方法。Objective:To explore efficacy and safety of ultrasound⁃guided venous branch ligation(UGLVB)in hemodialysis patients with arteriovenous fistula dysfunction.Methodology:The clinical data,operation plan and postoperative complications of patients who underwent UGLVB in the Department of Nephrology of Beijing Haidian Hospital from January 1,2018 to September 30,2022 were collected and analyzed retrospectively.The patients were divided into traditional incision and ligation group and UGLVB group.The baseline data,operation success rate,operation time,wound healing time and complications,patency of internal fistula and treatment cost were compared between the two groups.Results:A total of 44 patients were enrolled in this study,including 19 patients in UGLVB group and 25 patients in traditional ligation group.The most common reason for the ligation of vein branches is insufficient flow of the trunk(84.09%).The most common ligated vein is the dorsal branch of cephalic vein(54.55%).There was no significant difference in age,sex,basic kidney disease,common disease,dialysis age,internal fistula age,internal fistula opening time,cause and location of venous branch ligation between two groups(P>0.05).The wound healing time in UGLVB group was shorter than that in the traditional incision and ligation group(2.42±0.51 dvs12.72±1.49 d,t=-32.256,P=0.000).In terms of complications,there were 1 case of poor wound healing in the traditional incision and ligation group,2 cases in of mild bleeding UGLVB group,1 case in the traditional incision and ligation group,and 1 case of nerve injury in the incision and ligation group.There were no serious adverse events such as severe bleeding and infection in both groups.Conclusion:There is no significant difference in the success rate and complications between the UGLVB group and the traditional ligation of vein branches.The former is superior to the latter in reducing surgical trauma and wound healing,so it is a safe,effective and minimally invasive clinical operation.

关 键 词：动静脉内瘘 血液透析 静脉属支 结扎 

分 类 号：R459.5[医药卫生—治疗学]