两种不同动静脉内瘘术式的疗效观察

发布时间：2019-03-08 21:49

【摘要】：[目的]目前用于维持性血液透析通路的自体动静脉内瘘术式层出不穷,有桡动脉和头静脉的端端吻合、侧侧吻合、端侧吻合,改良的侧侧吻合,不同的术式有各自不同的优缺点,本实验通过探讨两种临床上常用动静脉内瘘术式(桡动脉与头静脉的端侧吻合术和桡动脉与头静脉改良式的侧侧吻合术)的治疗效果,以期寻找吻合口通畅率高、透析时血流量充足、术后并发症少的自体动静脉内瘘术式。[方法]回顾性分析2014年1月至2016年1月昆明医科大学第一附属医院肾内科行腕部动静脉内瘘吻合术进行血液透析的100例慢性肾功能衰竭患者。其中一组为实验组50例,行腕部桡动脉与头静脉改良式的侧侧吻合术,男性患者28例,女性患者22例,年龄19-74岁,平均年龄(46.6±15.0)岁;另外一组为对照组50例,行腕部桡动脉与头静脉的端侧吻合术,男性患者30例,女性患者20例,年龄22-76岁,平均年龄(48.9± 14.6)岁。比较两组手术成功率、手术总计时间、术后1周吻合口通畅率、透析时血流量及术后1年并发症情况,并对相关数据做统计学处理。[结果]两组所有手术均一次性成功,并且由同一个手术医师按着不同术式的具体要求和步骤完成,成功率100%;两组术后1周均未出现吻合口血栓形成,吻合口通畅,两组差异无统计学意义(P0.05);实验组手术所用时间明显短于对照组所用时间;实验组术后1年出现1例吻合口狭窄,术后1年内并发症发生率为2%,对照组术后1年出现5例吻合口堵塞,3例吻合口狭窄,术后1年内并发症发生率为16%;实验组透析时血流量明显大于对照组透析时血流量。两组在手术所用时间、术后1年并发症发生率、透析时血流量比较,差异有统计学意义(P0.05)。[结论]1、改良式的动静脉侧侧吻合术在手术时间、透析时血流量、术后并发症等方面优于动静脉端侧吻合术;2、改良式的动静脉侧侧吻合术其动静脉壁对位良好,不易产生血管扭曲、旋转、皱折,术后不易出现血管成角畸形,操作简单方便,手术时间缩短,术后并发症少,有一定的临床应用前景。
[Abstract]:[objective] at present, there are end-to-end anastomosis of radial artery and head vein, side-to-side anastomosis, end-to-side anastomosis and modified side-to-side anastomosis of autogenous arteriovenous fistula, which is used to maintain hemodialysis access. Different surgical methods have their own advantages and disadvantages. In this study, the therapeutic effects of two kinds of arteriovenous fistulas (end-to-side anastomosis between radial artery and cephalic vein and modified lateral anastomosis between radial artery and cephalic vein) were studied. In order to find autogenous arteriovenous fistula with high patency rate of anastomosis sufficient blood flow during dialysis and less complications after operation. [methods] from January 2014 to January 2016, 100 patients with chronic renal failure underwent carpal arteriovenous fistula anastomosis in the Department of Nephropathy, the first affiliated Hospital of Kunming Medical University. In one group, 50 patients in the experimental group underwent modified lateral anastomosis of the radial artery and the cephalic vein of the wrist. There were 28 male patients and 22 female patients, with an average age of (46.6 卤15.0) years, with a mean age of (46.6 卤15.0) years, and the mean age was (46.6 卤15.0) years old. In the other group, 50 patients were treated with end-to-side anastomosis of radial artery and cephalic vein in the wrist. There were 30 male patients and 20 female patients, with an average age of (48.9 卤14.6) years. The successful rate of operation, total operation time, anastomotic patency rate, blood flow during dialysis and complications in 1 year after operation were compared between the two groups, and the related data were analyzed statistically. [results] all the operations in the two groups were successful at one time and completed by the same surgeon according to the specific requirements and steps of different operations, with a success rate of 100%. One week after operation, there was no thrombosis of anastomotic opening in the two groups, and there was no significant difference between the two groups (P0.05), and the operation time in the experimental group was significantly shorter than that in the control group. One case of anastomotic stenosis occurred 1 year after operation in the experimental group, the incidence of complications was 2% in the first year after operation, 5 cases of anastomotic obstruction and 3 cases of anastomotic stenosis occurred in the 1 year after operation in the control group, and the incidence of complications was 16% in the 1 year after operation. The blood flow during dialysis in the experimental group was significantly higher than that in the control group. There were significant differences in the time of operation, the incidence of complications and blood flow during dialysis between the two groups (P0.05). [conclusion] 1, the modified arteriovenous anastomosis is superior to the end-to-side arteriovenous anastomosis in terms of operation time, blood flow during dialysis and postoperative complications. (2) the modified arteriovenous side-to-side anastomosis has the advantages of good alignment of the arteriovenous wall, not easy to produce vascular distortion, rotation, wrinkling, difficult to appear vascular angular deformity after operation, simple and convenient operation, shorter operation time and less complications after operation. It has a certain prospect of clinical application.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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