近端桡动脉内瘘的荟萃分析

发布时间：2018-10-26 15:16

【摘要】：目的： NFK/DOQI指南推荐尽量制作上肢远端动静脉内瘘,如果有合适的动静脉,腕部内瘘的风险显著低于移植血管和透析导管,并将成为长期透析通路的首选。由于糖尿病、高龄、既往透析导管植入史、外周血管病变等致使远端动静脉质量欠佳,腕部内瘘手术困难性明显增加,失败率显著提高。同时上臂肱动脉内瘘在盗血综合征、手臂缺血、高输出型心衰均有较高风险。1977年,Toledo-Pereyra和Gracz分别发表两篇文献首次描述前臂近端桡动脉内瘘(proximal radial artery fistula), Toledo-Pereyra将近端桡动脉和头静脉吻合,Gracz则将近端桡动脉和肘正中静脉或头静脉的深穿支进行吻合。以后的多项研究显示近端桡动脉内瘘以近端桡动脉(proximal radial artery)为流入端,表现出良好的通畅率,并允许多种静脉于肘窝处吻合。我们回顾了近端桡动脉内瘘(PRAAVF)的可行性及其效果,并论证这是一项有效的技术。方法：我们通过Pubmed系统性文献检索并查阅相关的参考文献确定入选文献。数据提取主要是：原始失败率(primary failure rate),1年及2年的原始通畅率(primary patency rate)和累积通畅率(secondary patency rate), PRAAVF手术的入选标准,吻合静脉种类,并发症。我们使用Stata12.0软件,用随机效应模式合并统计值,同时通过meta回归分析和敏感性分析探索异质性来源。结果：根据预先制定的筛选标准,经过1687篇文献的筛查,最终10篇文献(n=1310)被纳入荟萃分析。经过合并的原始失败率是12.3%(95%可信区间：7.6%-17.0%；χ2=70.8,12=87.3%)；包括原始失败率的1年和2年原始通畅率分别是73.6%(95%可信区间：52.4%-94.9%；χ2=71.3,12=97.2%),70.5%(95%可信区间：50.6%-90.5%；χ2=58.8,12=96.6%)；1年和2年累积通畅率分别是80.0%(95%可信区间：72.8-87.2；χ2＝24.42,12=75.4%),73.7%(95%可信区间：65.2-82.2；χ2=28.51,12=79.0%)。单因素meta回归分析发现原始失败率的定义差距是异质性的显著来源(p=0.009)。并发症发面：832中4个PRAAVF出现盗血综合征(0.5%),284中4个PRAAVF出现静脉高压(1.4%) 结论：近端桡动脉内瘘表现出低原始失败率,高原始通畅率和累积通畅率,同时并发症发生率低。因此建议制作血管通路时考虑到这种特殊内瘘,尤其是有腕部内瘘失败史或腕部血管不适宜。
[Abstract]:Objective: NFK/DOQI guidelines recommend that distal upper extremity arteriovenous fistula be made as far as possible. If appropriate arteriovenous fistula, the risk of wrist fistula is significantly lower than that of grafts and dialysis catheters, and will be the first choice of long-term dialysis pathway. Because of diabetes, advanced age, history of dialysis catheter implantation and peripheral vascular disease, the distal arteriovenous quality was poor, the operation difficulty of carpal internal fistula was obviously increased, and the failure rate was significantly increased. At the same time, brachial artery fistula in the upper arm is at high risk of steal syndrome, arm ischemia and high output heart failure. In 1977, Toledo-Pereyra and Gracz published two articles describing (proximal radial artery fistula), for the first time. The proximal radial artery and cephalic vein were anastomosed in Toledo-Pereyra, and the radial artery was anastomosed with the deep perforating branch of the median cubital vein or cephalic vein in Gracz. Subsequent studies have shown that the proximal radial artery internal fistula with proximal radial artery (proximal radial artery) as the inflow shows a good patency rate and allows multiple veins to be anastomosed at the cubital fossa. We reviewed the feasibility and effect of (PRAAVF) for proximal radial artery fistula and demonstrated that it is an effective technique. Methods: the selected literature was identified by Pubmed systematic literature retrieval and reference. The main data were: original failure rate (primary failure rate), original patency rate (primary patency rate) and cumulative patency rate (secondary patency rate), PRAAVF) for 1 and 2 years. We use Stata12.0 software to combine statistical values with random effect models, and explore the source of heterogeneity by meta regression analysis and sensitivity analysis. Results: according to the pre-established screening criteria, 10 articles (nn 1310) were included in the meta-analysis after screening of 1687 articles. The original failure rate was 12.3% (95% confidence interval: 7.6-17.0, 蠂 2 70.81.28%). The original patency rates of 1 year and 2 years including the original failure rate were 73.6% (95% CI: 52.4-94.9), 70.5% (95% CI: 50.6-90.5%), 70.5% (蠂 2 + 71.3% -1297.2%), 70.5% (95% CI: 50.6-90.5%), 70.5% (95% CI: 52.4-90.5%) respectively. The cumulative patency rates were 80.0% (95% CI: 72.8-87.2%), 73.7% (95% CI: 65.2-82.2%), 73.7% (95% CI: 65.2-82.2), 73.7% (95% CI: 72.8-87.2%), 73.7% (95% CI: 65.2-82.2), 73.7% (95% CI: 65.2-82.2) respectively. 蠂 2: 28.51%). Univariate meta regression analysis showed that the difference in the definition of the original failure rate was a significant source of heterogeneity (p0. 009). Complications: 4 out of 832 (0.5%) PRAAVF had steal syndrome and 4 (1.4%) of 284 PRAAVF had venous hypertension. Conclusion: proximal radial artery internal fistula showed a low primary failure rate. High primary patency rate and cumulative patency rate, and low incidence of complications. Therefore, it is recommended that this special fistula be taken into account in the fabrication of vascular pathways, especially if there is a history of failure of the internal fistula of the wrist or the vessels of the wrist are not suitable.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

【共引文献】