CAJ | 학술논문

目的：比较肘下与肘上高位动静脉内瘘应用于尿毒症患者血液透析的效果。方法45例前臂内瘘堵塞或前臂血管条件差无法在该部位手术的尿毒症患者，按手术方法不同分为肘下高位动静脉内瘘组（肘下内瘘组）25例和肘上高位动静脉内瘘组（肘上内瘘组）20例。肘下内瘘组行桡动脉-正中静脉或其交通静脉端侧吻合术，肘上内瘘组行肱动脉-肘正中静脉或贵要静脉端侧吻合术。对比两组手术时间、术中出血量、手术成功率、血液透析径路、血流量、通畅率，术后心力衰竭、肢体肿胀、窃血综合征以及假性动脉瘤发生率等。结果两组患者手术均获得成功，均通畅。肘下内瘘组血液透析径路长于肘上内瘘组（P＜0．05），手术时间、术中出血量均明显少于肘上内瘘组（P＜0．05）。肘下内瘘组血流量稍低于肘上内瘘组，但差异无统计学意义（P＞0．05）。两组均未发生假性动脉瘤，肘下内瘘组术后无充血性心力衰竭、肢体肿胀、窃血综合征等并发症。肘上内瘘组术后发生充血性心力衰竭3例（15．0％）、肢体肿胀3例（15．0％）、窃血综合征1例（5．0％）。肘上内瘘组充血性心力衰竭、肢体肿胀发生率均明显高于肘下内瘘组（P＜0．05），两组窃血综合征发生率比较，差异无统计学意义（P＞0．05）。结论肘下与肘上动静脉内瘘均能满足血液透析要求，但前者比后者并发症少、获得较长血透径路，更具优势。
목적：비교주하여주상고위동정맥내루응용우뇨독증환자혈액투석적효과。방법45례전비내루도새혹전비혈관조건차무법재해부위수술적뇨독증환자，안수술방법불동분위주하고위동정맥내루조（주하내루조）25례화주상고위동정맥내루조（주상내루조）20례。주하내루조행뇨동맥-정중정맥혹기교통정맥단측문합술，주상내루조행굉동맥-주정중정맥혹귀요정맥단측문합술。대비량조수술시간、술중출혈량、수술성공솔、혈액투석경로、혈류량、통창솔，술후심력쇠갈、지체종창、절혈종합정이급가성동맥류발생솔등。결과량조환자수술균획득성공，균통창。주하내루조혈액투석경로장우주상내루조（P＜0．05），수술시간、술중출혈량균명현소우주상내루조（P＜0．05）。주하내루조혈류량초저우주상내루조，단차이무통계학의의（P＞0．05）。량조균미발생가성동맥류，주하내루조술후무충혈성심력쇠갈、지체종창、절혈종합정등병발증。주상내루조술후발생충혈성심력쇠갈3례（15．0％）、지체종창3례（15．0％）、절혈종합정1례（5．0％）。주상내루조충혈성심력쇠갈、지체종창발생솔균명현고우주하내루조（P＜0．05），량조절혈종합정발생솔비교，차이무통계학의의（P＞0．05）。결론주하여주상동정맥내루균능만족혈액투석요구，단전자비후자병발증소、획득교장혈투경로，경구우세。
Objective To compare the effects between the below-the-elbow high arterio-venous fistula (BEHAVF) and the above-the-elbow high arterio-venou fistula ( AEHAVF ) applied to hemodialysis patients with uremia .Methods Forty-five patients with uremia ,whose forearm fistulas were blocked or whose vascular conditions of the forearm were too bad to receive an operation ,were divided into BEHAVF group ( 25 cases ) and AEHAVF group ( 20 cases ) according to the different surgical methods .The BEHAVF group was given an end-to-side anastomosis of the radial artery and the median vein or the perforating vein .The AEHAVF group was given an end-to-side anastomosis of the brachial artery and the median cubital vein or the basilic vein .The operative time ,intraoperative blood loss ,operation success rate , vascular access in hemodialysis ,blood flow ,patency rate ,and the incidences of postoperative heart failure ,arm edema , steal syndrome and pseudoaneurysm were compared between two groups .Results The operations of two groups were successful and smooth .The vascular accesse in hemodialysis of BEHAVF group was longer than that of AEHAVF group (P<0.05),and the operative time and intraoperatve blood loss were less than those of AEHAVF group (P<0.05). The blood flow was less in the BEHAVF group in contrast with that in the AEHAVF group ,which showed no significant difference between two groups(P>0.05).Pseudoaneurysm did not occur in the two groups .Postoperative heart failure ,arm edema and steal syndrome did not occur in the BEHAVF group .There were 3 cases ( 15%) of congestive postoperative heart failure , 3 cases ( 15%) of arm edema and 1 case ( 5%) of steal syndrome in the AEHAVF group .The incidences of postoperative heart failure and arm edema in the BEHAVF group were significantly higher than those in the AEHAVF group (P<0.05).There was no significant difference in the steal syndrome between two groups (P>0.05). Conclusion Both BEHAVF and AEHAVF can meet the requirements of hemodialysis ,but the former is better than the latter for its advantages of less complications and a longer vascular access in hemodialysis .