摘要
目的 探讨完全“不接触”静脉血管处理技术建立血液透析患者自体动静脉内瘘(AVF)的临床效果。 方法 回顾性纳入2021年1月至2022年8月苏州科技城医院肾内科采用完全“不接触”静脉血管处理技术首次建立AVF的患者63例,收集患者临床资料、AVF超声评估数据、AVF成熟率和通畅率,并与本院2019年1月至2020年12月常规手术组患者进行比较。Kaplan-Meier法绘制生存曲线,log-rank检验比较术后通畅率的差异。 结果 完全“不接触”静脉血管处理技术组63例,男39例,女24例,年龄(60±17)岁;常规手术组40例,男23例,女17例,年龄(60±13)岁。完全“不接触”静脉血管处理技术组患者术后即时通畅率100%(63/63),术后2、4、8周AVF成熟率分别为54.0%(34/63)、85.7%(54/63)、90.5%(57/63)。术后3、6、9个月和1年初始通畅率分别为90.0%(45/50)、85.0%(34/40)、82.9%(29/35)和81.0%(17/21),辅助通畅率均为100.0%。1年初始通畅率高于常规手术组患者(81.0%比63.5%,log-rank χ^(2) =5.12, P =0.023)。超声结果提示完全“不接触”静脉血管处理技术组患者术后AVF流出静脉均匀扩张,血管壁逐渐增厚,肱动脉血流量逐渐升高,头静脉和桡动脉均呈现螺旋层流。 结论 完全“不接触”静脉血管处理技术用于建立AVF成熟快,通畅率高,值得临床推广。
Objective To explore the clinical efficacy of a modified no-touch technique(MNTT)in establishing autogenous arteriovenous fistulas(AVF)in hemodialysis patients.Methods A total of 63 patients with AVF which was first established by MNTT in the Department of Nephrology,Suzhou Science and Technology Town Hospital from January 2021 to August 2022 were retrospectively included.The clinical data,ultrasound evaluation data of AVF,AVF maturity rate and AVF patency rate were collected.Subsequently,the AVF rate of patients in the MNTT group was compared with the patency rate of patients in the conventional operation group in the same hospital from January 2019 to December 2020.The Kaplan-Meier method was used to draw the survival curve,and the log-rank test was used to compare the difference in postoperative patency rate between the two groups.Results There were 63 cases in the MNTT group,with 39 males and 24 females,and aged(60±17)years.Meanwhile,there were 40 cases in the conventional operation group,including 23 males and 17 females,and aged(60±13)years.In the MNTT group,the immediate patency rate was 100%(63/63)after surgery,and the AVF maturation rate at 2,4 and 8 weeks postoperatively were 54.0%(34/63),85.7%(54/63),and 90.5%(57/63),respectively.The primary patency rate was 90.0%(45/50),85.0%(34/40),82.9%(29/35),and 81.0%(17/21)at 3,6,9 months,and 1 year after the operation,respectively,and the assisted patency rates were all 100.0%.The one-year primary patency rate in the MNTT group was higher than that in the conventional surgery group(81.0%versus 63.5%,log-rank χ^(2)=5.12,P=0.023).Ultrasound results showed that in the MNTT group,AVF veins were evenly dilated,the vascular wall gradually thickened,the brachial artery blood flow gradually increased,and spiral laminar flow occurred in the cephalic vein and radial artery.Conclusion AVF established by MNTT features with fast maturity and a high patency rate,which is worthy of clinical promotion.
作者
王晓禾
董萍
刘振
张元元
侯国存
Wang Xiaohe;Dong Ping;Liu Zhen;Zhang Yuanyuan;Hou Guocun(Department of Nephrology,Suzhou Science&Technology Town Hospital,Suzhou 215000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第10期714-719,共6页
National Medical Journal of China
基金
苏州市科技发展计划-医疗卫生科技创新(SKY2021030)
苏州市科技计划项目(SYS2020077)
关键词
肾透析
动静脉瘘
手术后并发症
Renal dialysis
Arteriovenous fistula
Postoperative complications
