手鼻烟窝部动静脉内瘘在血液透析中的临床应用研究

目的探讨鼻烟窝动静脉内瘘在维持性血液透析中的临床应用.方法采用显微外科技术对169例慢性肾功能衰竭血液透析患者行直接动静脉内瘘术,分别为鼻烟窝部83例,前臂远端腕部86例(Cimino瘘),比较两组内瘘成熟时间、血流量、近远期通畅率及并发症等.结果两组在内瘘成熟时间、血流量上无显著差异(P>0.05).鼻烟窝瘘和Cimino瘘的通畅率分别为:4周96.4%和95.3%(P>0.05),1年为92.6%和80.7%(P<0.05),2年为86.7%和72.2%(P<0.05),3年为81.4%和63.0%(P<0.05).鼻烟窝瘘及Cimino瘘栓塞发生率分别为 18.6% 和 37.0%(P<0.05), 动脉瘤发生率分别为 14.3% 和 30.1%(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,保留了近端血管以备重建内瘘,是血液透析最佳的永久性血管通路.

Clinical application study with snuffbox arteriovenous fistula for hemodialysis

Objective To evaluate the clinical application of snuffbox arteriovenous fistula(SAF) in maintenance hemodialysis. Methods One hundred and sixty-nine direct internal arteriovenous fistulas(DIAF) for hemodialysis patients with chronic renal failure(CRF) were e stablished under microsurgery, 83 bein g at anatomical snuffbox and 86 at wrist of distal forearm(Cimino fistula,CF). The time of mature, the volume of blood flow, the patency rate of short-term and long-term,and complications in DIAF were observed. Results There were no significant differences in two groups of S AF and CF on the time of mature and the volume of blood flow(P>0.05). The patency rates in SAF and CF were 96.4% vs 95.3% in four weeks(P >0.05),92.6% vs 80.7% in one year (P < 0.05),86.7% vs 72 .2% in two year(P<0.05) and 81.4% vs 63.0% in three year(P< 0.05). The incidence rates of thrombosis in SAF and CF were 18.6% and 37 .0% respectively (P<0.05), and that of aneurysm were 14.3% and 3 0.1% respectively (P<0.05). Conclusions Performing easily, having a better long-term patency rate and fewer complications, sparing the proximal vessels for reoperation if n ecessary, the snuffbox arteriovenous fistula is the most advisable permanent vas cular access in hemodialysis.