【摘要】：目的： NFK/DOQI指南推薦盡量制作上肢遠(yuǎn)端動(dòng)靜脈內(nèi)瘺,如果有合適的動(dòng)靜脈,腕部內(nèi)瘺的風(fēng)險(xiǎn)顯著低于移植血管和透析導(dǎo)管,并將成為長期透析通路的首選。由于糖尿病、高齡、既往透析導(dǎo)管植入史、外周血管病變等致使遠(yuǎn)端動(dòng)靜脈質(zhì)量欠佳,腕部內(nèi)瘺手術(shù)困難性明顯增加,失敗率顯著提高。同時(shí)上臂肱動(dòng)脈內(nèi)瘺在盜血綜合征、手臂缺血、高輸出型心衰均有較高風(fēng)險(xiǎn)。1977年,Toledo-Pereyra和Gracz分別發(fā)表兩篇文獻(xiàn)首次描述前臂近端橈動(dòng)脈內(nèi)瘺(proximal radial artery fistula), Toledo-Pereyra將近端橈動(dòng)脈和頭靜脈吻合,Gracz則將近端橈動(dòng)脈和肘正中靜脈或頭靜脈的深穿支進(jìn)行吻合。以后的多項(xiàng)研究顯示近端橈動(dòng)脈內(nèi)瘺以近端橈動(dòng)脈(proximal radial artery)為流入端,表現(xiàn)出良好的通暢率,并允許多種靜脈于肘窩處吻合。我們回顧了近端橈動(dòng)脈內(nèi)瘺(PRAAVF)的可行性及其效果,并論證這是一項(xiàng)有效的技術(shù)。 方法： 我們通過Pubmed系統(tǒng)性文獻(xiàn)檢索并查閱相關(guān)的參考文獻(xiàn)確定入選文獻(xiàn)。數(shù)據(jù)提取主要是：原始失敗率(primary failure rate),1年及2年的原始通暢率(primary patency rate)和累積通暢率(secondary patency rate), PRAAVF手術(shù)的入選標(biāo)準(zhǔn),吻合靜脈種類,并發(fā)癥。我們使用Stata12.0軟件,用隨機(jī)效應(yīng)模式合并統(tǒng)計(jì)值,同時(shí)通過meta回歸分析和敏感性分析探索異質(zhì)性來源。 結(jié)果： 根據(jù)預(yù)先制定的篩選標(biāo)準(zhǔn),經(jīng)過1687篇文獻(xiàn)的篩查,最終10篇文獻(xiàn)(n=1310)被納入薈萃分析。經(jīng)過合并的原始失敗率是12.3%(95%可信區(qū)間：7.6%-17.0%；χ2=70.8,12=87.3%)；包括原始失敗率的1年和2年原始通暢率分別是73.6%(95%可信區(qū)間：52.4%-94.9%；χ2=71.3,12=97.2%),70.5%(95%可信區(qū)間：50.6%-90.5%；χ2=58.8,12=96.6%)；1年和2年累積通暢率分別是80.0%(95%可信區(qū)間：72.8-87.2；χ2＝24.42,12=75.4%),73.7%(95%可信區(qū)間：65.2-82.2；χ2=28.51,12=79.0%)。單因素meta回歸分析發(fā)現(xiàn)原始失敗率的定義差距是異質(zhì)性的顯著來源(p=0.009)。并發(fā)癥發(fā)面：832中4個(gè)PRAAVF出現(xiàn)盜血綜合征(0.5%),284中4個(gè)PRAAVF出現(xiàn)靜脈高壓(1.4%) 結(jié)論： 近端橈動(dòng)脈內(nèi)瘺表現(xiàn)出低原始失敗率,高原始通暢率和累積通暢率,同時(shí)并發(fā)癥發(fā)生率低。因此建議制作血管通路時(shí)考慮到這種特殊內(nèi)瘺,尤其是有腕部內(nèi)瘺失敗史或腕部血管不適宜。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.5

【共引文獻(xiàn)】

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本文編號：2296137