2018 年第 10 期 第 13 卷

动脉硬化患者动静脉内瘘术不同血管吻合方法的临床效果比较

Clinical effects of different vascular anastomosis methods on arteriovenous fistula in arteriosclerotic patients

作者：苏铁柱宗双乐齐巍琚绍静李立东李力更吴志新

英文作者：

单位：063000河北省唐山市第二医院创伤四科（苏铁柱、李力更、吴志新），创伤二科（宗双乐、李立东），创伤一科（齐巍、琚绍静）

英文单位：

关键词：动静脉内瘘；动脉硬化；显微镜；间断吻合；连续吻合

英文关键词：

• 摘要：

• 【摘要】目的    探讨动脉硬化患者动静脉内瘘术不同血管吻合方法的临床效果。方法    选取2009年1月至2016年11月在河北省唐山市第二医院因终末期肾病需行动静脉内瘘术维持长期血液透析的存在动脉硬化的患者130例。根据临床状况进而实施的吻合方式不同分为显微镜下间断缝合组（100例）和显微镜下连续缝合组（30例）。所选择动脉血管管腔≥1.5 mm，静脉直径≥2.0 mm，采用显微镜下间断吻合或连续吻合方式对头静脉-桡动脉行端-侧吻合。术后均随访24个月，分别观察早期血栓形成(3周内)、迟发性血栓形成、吻合口狭窄、窃血综合征等并发症发生情况以及术后2年通畅率。结果    随访24个月，2组间术后早期血栓、迟发性血栓、盗血综合征发生率差异无统计学意义(均P>0.05)。显微镜下间断吻合组术后吻合口狭窄的发生率低于显微镜下连续吻合组［5.0%（5/100）比60.0%（18/30）］，差异有统计学意义(P<0.05)。术后2年显微镜下间断吻合组患者动静脉内瘘通畅率明显高于显微镜下连续吻合组［95.0%（95/100）比40.0%（12/30）］，差异有统计学意义（P<0.05）。结论    动脉硬化患者行动静脉内瘘术，选择直径≥1.5 mm的动脉，直径≥2.0 mm的静脉血管，在显微镜下间断吻合通畅率优于连续吻合，显微镜下间断吻合是自体动-静脉内瘘吻合较好的选择。

• 【Abstract】Objective    To explore the clinical effects of different vascular anastomosis methods on arteriovenous fistula in arteriosclerotic patients. Methods    From January 2009 to November 2016, 130 patients with arteriosclerosis requiring maintenance hemodialysis due to end-stage renal disease in the Second Hospital of Tangshan were enrolled. They had arteriovenous fistula through different vascular anastomosis methods according to individual condition; 100 patients had interrupted suture under microscope and 30 patients had continuous suture. End-to-side anastomosis was performed at cephalic vein-radial artery; the arterial lumen diameter was more than 1.5 mm; the vein diameter was more than 2.0 mm. All patients were followed up for 24 months; complications including early thrombosis(within 3 weeks), delayed thrombosis, anastomotic stenosis, artery steal syndrome and the 2-year patency were observed. Results    During 24 months of follow-up, there was no significant difference in the incidences of early thrombosis, delayed thrombosis and artery steal syndrome between groups(P>0.05). Incidence of anastomotic stenosis in the interrupted suture group was significantly lower than that in the continuous suture group［5.0%(5/100) vs 60.0%(18/30)］(P<0.05). The 2-year patency rate of arteriovenous fistula in the interrupted suture group was significantly higher than that in the continuous suture group［95.0%（95/100） vs 40.0%（12/30）］(P<0.05). Conclusion    In patients with arteriosclerosis, interrupted suture using artery wilder than 1.5 mm and vein wilder than 2.0 mm is a better for arteriovenous fistula than continuous suture.