侧侧吻合术式在鼻烟窝部内瘘建立中应用的临床研究

目的：探讨侧侧吻合术式在鼻烟窝动静脉内瘘成形术中应用作为维持性透析患者内瘘首选术式的优势。方法：将45例首次建立动静脉内瘘的慢性肾衰竭患者随机分为两组，治疗组30例，以侧侧吻合方式在鼻烟窝处行动静脉内瘘成形术，对照组15例，在腕部建立动静脉内瘘。比较两组的手术成功率、术后并发症，彩超测得术后8周及1、2年吻合口血流量及动脉瘤形成率。结果：侧侧吻合术可保证动静脉吻合口足够长度，从而保障了内瘘应用中足够的血流量，术后1、2年治疗组吻合口血流量更大，分别为（952±176）ml／min、（896±103）ml／min，对照组分别为（847±110）ml／min、（795±98）ml／min，两组比较，差异有统计学意义（P〈0．05）；术后1、2年治疗组动脉瘤形成率更小，分别为3．33％、10．0％，对照组分别为33．3％、40．0％，两组比较，差异有统计学意义（P〈0．05）。结论：鼻烟窝动静脉内瘘制作简便，远期通畅率高，并发症少，保留了近端血管可以在腕部再建标准内瘘，是血管条件良好尿毒症患者首选的永久性血管通路。侧侧吻合术式可作为鼻烟窝内瘘首选术式。

Clinical research of application of side-to-side anastomosis in establishment of snuffbox fistula

Objective: To investigate the advantages of side-to-side anastomosis in snuffbox arteriovenous fistula plasty as the preferred surgical method for maintenance dialysis patients.Methods: 45 patients with chronic renal failure having ar-teriovenous fistula establishment were randomly divided into two groups,treatment group of 30 patients were received snuffbox arteriovenous fistula plasty by the method of side-to-side anastomosis while control group of 15 patients were re-ceived wrist arteriovenous fistula pl...