CAJ | 학술논문

目的比较间断结节吻合与连续吻合两种不同方法在前臂动静脉内瘘手术中的临床效果,结合文献总结治疗经验,以期进一步提高手术效果.方法 76例施行前臂动静脉内瘘术的患者被随机分为两组:其中间断结节吻合38例,连续吻合38例,两组均采用端-侧吻合.比较两种吻合方法在血管吻合时间、总体手术时间、术后血管通畅度及血管并发症的差异并作统计学分析.结果血管吻合时间间断结节吻合组平均为(27.4±5.2)min、连续缝合组为(18.4±4.6) min,差异具有统计学意义(P＜0.05)；总体手术时间间断结节吻合组平均为(68.6±18.4) min、连续缝合组为(54.8±12.2)min；差异具有统计学意义(P＜0.05).内瘘成熟后血流量间断结节吻合组平均为(647.6±102.8) ml/min、连续吻合组为(604.8±82.5)ml/min,差异具有统计学意义(P＜0.05).术后1个月、6个月和1年通畅率分别为间断结节吻合组100％(38/38)、97.4％(37/38)、97.4％(37/38),连续缝合组97.4％(37/38)、94.7％(36/38)、94.7％ (36/38)；两组间均无统计学差异(P＞0.05).结论连续吻合建立动静脉内瘘血管吻合时间及总体手术时间比间断结节吻合更短,而近远期通畅率与间断吻合无明显差异,但内瘘成熟后血流量较间断结节吻合小.因此,采用个体化方案决定吻合方式可能对患者更有利.
목적 비교간단결절문합여련속문합량충불동방법재전비동정맥내루수술중적림상효과,결합문헌총결치료경험,이기진일보제고수술효과.방법 76례시행전비동정맥내루술적환자피수궤분위량조:기중간단결절문합38례,련속문합38례,량조균채용단-측문합.비교량충문합방법재혈관문합시간、총체수술시간、술후혈관통창도급혈관병발증적차이병작통계학분석.결과 혈관문합시간간단결절문합조평균위(27.4±5.2)min、련속봉합조위(18.4±4.6) min,차이구유통계학의의(P＜0.05)；총체수술시간간단결절문합조평균위(68.6±18.4) min、련속봉합조위(54.8±12.2)min；차이구유통계학의의(P＜0.05).내루성숙후혈류량간단결절문합조평균위(647.6±102.8) ml/min、련속문합조위(604.8±82.5)ml/min,차이구유통계학의의(P＜0.05).술후1개월、6개월화1년통창솔분별위간단결절문합조100％(38/38)、97.4％(37/38)、97.4％(37/38),련속봉합조97.4％(37/38)、94.7％(36/38)、94.7％ (36/38)；량조간균무통계학차이(P＞0.05).결론 련속문합건립동정맥내루혈관문합시간급총체수술시간비간단결절문합경단,이근원기통창솔여간단문합무명현차이,단내루성숙후혈류량교간단결절문합소.인차,채용개체화방안결정문합방식가능대환자경유리.
Objectives To compare the efficacy of discontinuous anastomosis and continuous anastomosis for arteriovenous fistula plasty of forearm in hemodialysis patients,referring to the literature and summarize our experience to improve the operation outcome.Methods Totally 76 patients operating for arteriovenous fistula plasty of forearm were randomized divided into 2 groups:38 patients received discontinuous anastomosis and 38 patients received continuous anastomosis.The two groups were all used for end-to-side anastomosis.Comparing the time of vascular anastomosis、total operation time 、patency rates and complications and make statistical analysis.Results The mean time of vascular anastomosis are (27.4 ± 5.2) min and (18.4 ± 4.6) min in discontinuous anastomosis group and continuous anastomosis group respectivly,with a statistical significant difference (p ＜ 0.05) ;The mean total operation time are (68.6 ± 18.4) min and (54.8 ± 12.2) min in discontinuous anastomosis group and continuous anastomosis group respectivly,with a statistical significant difference (P ＜ 0.05).The average blood flow after mature formation of fistulas in the discontinuous anastomosis group was(647.6 ± 102.8) ml/min 、while that in the continuous anastomosis group was (604.8 ± 82.5) ml/min,with a statistical difference (P ＜ 0.05).The 1-month,6-month,and 12-month patency rates in discontinuous anastomosis group and continuous anastomosis group were 100％ (38/38) 、97.4％ (37/38) 、97.4％ (37/38) and 97.4％ (37/38) 、94.7％ (36/38) 、94.7％ (36/38) respectivly,witn no statistical difference(P ＞ 0.05).Conclusions The continuous anastomosis for arteriovenous fist -ula plasty can get a shotter time both in vascular anastomosis and total operation procedure than the discontinuous anastomosis,and the short-term and long-term patency rates are similar,but the blood flow after mature formation of fistulas was smaller than the discontinuous anastomosis.Thus,according to the patients'individual condition to decide different anastomosis methods could be more beneficial for the patients.