發(fā)布時(shí)間：2019-03-08 21:49

【摘要】：[目的]目前用于維持性血液透析通路的自體動靜脈內(nèi)瘺術(shù)式層出不窮,有橈動脈和頭靜脈的端端吻合、側(cè)側(cè)吻合、端側(cè)吻合,改良的側(cè)側(cè)吻合,不同的術(shù)式有各自不同的優(yōu)缺點(diǎn),本實(shí)驗(yàn)通過探討兩種臨床上常用動靜脈內(nèi)瘺術(shù)式(橈動脈與頭靜脈的端側(cè)吻合術(shù)和橈動脈與頭靜脈改良式的側(cè)側(cè)吻合術(shù))的治療效果,以期尋找吻合口通暢率高、透析時(shí)血流量充足、術(shù)后并發(fā)癥少的自體動靜脈內(nèi)瘺術(shù)式。[方法]回顧性分析2014年1月至2016年1月昆明醫(yī)科大學(xué)第一附屬醫(yī)院腎內(nèi)科行腕部動靜脈內(nèi)瘺吻合術(shù)進(jìn)行血液透析的100例慢性腎功能衰竭患者。其中一組為實(shí)驗(yàn)組50例,行腕部橈動脈與頭靜脈改良式的側(cè)側(cè)吻合術(shù),男性患者28例,女性患者22例,年齡19-74歲,平均年齡(46.6±15.0)歲;另外一組為對照組50例,行腕部橈動脈與頭靜脈的端側(cè)吻合術(shù),男性患者30例,女性患者20例,年齡22-76歲,平均年齡(48.9± 14.6)歲。比較兩組手術(shù)成功率、手術(shù)總計(jì)時(shí)間、術(shù)后1周吻合口通暢率、透析時(shí)血流量及術(shù)后1年并發(fā)癥情況,并對相關(guān)數(shù)據(jù)做統(tǒng)計(jì)學(xué)處理。[結(jié)果]兩組所有手術(shù)均一次性成功,并且由同一個(gè)手術(shù)醫(yī)師按著不同術(shù)式的具體要求和步驟完成,成功率100%;兩組術(shù)后1周均未出現(xiàn)吻合口血栓形成,吻合口通暢,兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組手術(shù)所用時(shí)間明顯短于對照組所用時(shí)間;實(shí)驗(yàn)組術(shù)后1年出現(xiàn)1例吻合口狹窄,術(shù)后1年內(nèi)并發(fā)癥發(fā)生率為2%,對照組術(shù)后1年出現(xiàn)5例吻合口堵塞,3例吻合口狹窄,術(shù)后1年內(nèi)并發(fā)癥發(fā)生率為16%;實(shí)驗(yàn)組透析時(shí)血流量明顯大于對照組透析時(shí)血流量。兩組在手術(shù)所用時(shí)間、術(shù)后1年并發(fā)癥發(fā)生率、透析時(shí)血流量比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]1、改良式的動靜脈側(cè)側(cè)吻合術(shù)在手術(shù)時(shí)間、透析時(shí)血流量、術(shù)后并發(fā)癥等方面優(yōu)于動靜脈端側(cè)吻合術(shù);2、改良式的動靜脈側(cè)側(cè)吻合術(shù)其動靜脈壁對位良好,不易產(chǎn)生血管扭曲、旋轉(zhuǎn)、皺折,術(shù)后不易出現(xiàn)血管成角畸形,操作簡單方便,手術(shù)時(shí)間縮短,術(shù)后并發(fā)癥少,有一定的臨床應(yīng)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 鹵15.0) years, with a mean age of (46.6 鹵15.0) years, and the mean age was (46.6 鹵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 鹵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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5

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