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目的探讨上肢3种不同手术部位和吻合方法的自体动-静脉内瘘在维持性血液透析中的临床应用效果。方法采用显微外科技术为322例维持性血液透析患者建立上肢自体动-静脉内瘘,根据手术部位和血管吻合方法不同分为3组:腕部标准内瘘215例(A组),肘部端侧吻合内瘘组54例(B组),肘部侧侧吻合内瘘组53例(C组)。比较术后2周和4周内瘘血流量、术后至开始应用时间、1、2年通畅率及并发症。结果 A组术后2周和4周内瘘血流量低于其他两组,术后至开始应用时间长于其他两组(P<0.05);3组的1、2年通畅率无统计学差异;B组血栓形成、假性动脉瘤发生率高于其他两组(P<0.05)。结论肘部侧侧吻合内瘘具有和腕部标准内瘘一样并发症少的优点,又具有肘部端侧吻合内瘘成熟快、血流量高的优点。
Objective To investigate the clinical application of autologous arteriovenous fistula in maintenance hemodialysis in 3 different surgical sites and anastomosis of upper limbs. Methods According to the surgical site and vascular anastomosis, 322 cases of maintenance hemodialysis patients were divided into 3 groups according to the technique of microsurgery: 215 cases of standard internal fistula of wrist (group A), elbow 54 cases of end-to-side fistula (group B), 53 cases of side-to-side fistula (group C). The fistula blood flow, postoperative to initial application time, 1,2 year patency and complications were compared between two weeks and four weeks after operation. Results The blood flow of fistula in group A was lower than that of the other two groups in two weeks and four weeks after operation, and the application time was longer in the two groups after operation than in the other two groups (P <0.05). There was no significant difference between the two groups In group B, the incidence of thrombosis and pseudoaneurysm was higher than the other two groups (P <0.05). Conclusion The anastomotic fistula of the elbow has the same advantages as the standard fistula of the wrist with less complications, but also has the advantages of rapid maturation and high blood flow of the anastomotic fistula of the elbow.