改良端側吻合結合機械及液壓擴張法在動靜脈內(nèi)瘺術中的應用觀察

馮錫光+陳俊柱+張敏

【摘要】 目的：探討尿毒癥晚期需血液透析患者采用改良端側吻合結合機械和液壓擴張法的動靜脈內(nèi)瘺術的效果，為臨床提供高效、安全的手術方法。方法：選取2013年1月-2017年2月本院要做血液透析的尿毒癥晚期患者70例作為研究對象，其中2013年1月-2015年6月40例患者采用傳統(tǒng)端側吻合內(nèi)瘺術為對照組，2015年7月-2017年2月30例采用改良端側吻合結合機械及液壓擴張法動靜脈內(nèi)瘺術為觀察組，以術后3個月為觀察期，比較兩組吻合管徑、頭靜脈血流量、手術優(yōu)良率、成功率、術后并發(fā)癥發(fā)生情況。結果：觀察組的吻合管徑、頭靜脈血流量、手術優(yōu)良率均優(yōu)于對照組（P<0.05），但是兩組成功率比較差異無統(tǒng)計學意義（P>0.05）；觀察組發(fā)生內(nèi)瘺管血栓、手腫脹、吻合口狹窄等并發(fā)癥均明顯低于對照組，僅吻合口狹窄差異有統(tǒng)計學意義（P<0.05），其他各項比較差異均無統(tǒng)計學意義（P>0.05）。結論：尿毒癥晚期血液透析患者改良端側吻合結合機械及液壓擴張法動靜脈內(nèi)瘺術，具有提高手術成功率、并發(fā)癥發(fā)生率低等臨床特點，同時能夠改善靜脈條件較差患者的靜脈管徑，加強內(nèi)瘺的血流量，保證透析治療的成功率。

【關鍵詞】 改良端側吻合； 機械； 液壓擴張法； 動靜脈內(nèi)瘺術

【Abstract】 Objective：To investigate the effect of improved end-to-side anastomosis combined with mechanical and hydraulic expansion method in internal arteriovenous fistula surgery of uremic late hemodialysis patients， so as to provide an efficient and safe surgical procedure for the patients. Method：70 cases of advanced uremia with hemodialysis from January 2013 to February 2017 were selected as the subjects.40 patients with traditional end-to-side internal anastomosis fistula from January 2013 to June 2015 were chosen as the control group.30 patients with improved end-to-side anastomosis combined with mechanical and hydraulic expansion method in arteriovenous fistula surgery from July 2015 to February 2017 were chosen as the observation group.

3 months after surgery was the observation period. The anastomotic diameter， head venous blood flow， excellent and good rate， success rate and postoperative complications of two groups were compared. Result：The anastomosis diameter， head venous blood flow and excellent operation rate of the observation group were better than those of the control group （P<0.05）， but there was no significant difference of the success rate between two groups （P>0.05）. The occurrence of internal fistula thrombosis， swelling of the hand， anastomotic stenosis and other complications in the observation group were significantly lower than the control group，the anastomotic stenosis was different （P<0.05），but the other the other complications differences were without statistical significance（P>0.05）.Conclusion：The improved end-to-side anastomosis combined with mechanical and hydraulic dilation arteriovenous fistula in patients with advanced uremia hemodialysis has the clinical features of improving the success rate and low complication rate， and can improve the venous blood vessel diameter， strengthen the internal fistula blood flow， and ensure the success rate of dialysis treatment.

【Key words】 Improved end-to-side anastomosis； Mechanical； Hydraulic expansion method； Internal arteriovenous fistula surgeryendprint

First-authors address：Peoples Hospital of Yingde City，Yingde 513000，China

doi：10.3969/j.issn.1674-4985.2017.29.029

尿毒癥是腎功能喪失患者機體內(nèi)生化過程發(fā)生紊亂的一種復雜綜合征。研究顯示，尿毒癥患者的腎臟發(fā)生衰竭后，毒素不能排除體外，從而在體內(nèi)逐漸蓄積，嚴重影響患者機體各組織系統(tǒng)發(fā)生損害。在我國有近200萬的尿毒癥患者，并且每年以20%的新發(fā)病率遞增[1]。目前我國有超過130萬需要進行血液透析治療的晚期尿毒癥患者[2]?！?br>