中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (31): 5837-5840.doi: 10.3969/j.issn.1673-8225.2010.31.034

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

鼻烟窝和前臂动静脉内瘘应用于慢性肾功能衰竭维持血液透析214例：哪种方法更适合肾移植前的永久血管通路　

王  涛，郭东阳，魏  萌，王  英，张  凡   

  1. 解放军成都军区总医院肾脏内科，四川省成都市 610083
  • 出版日期:2010-07-30 发布日期:2010-07-30
  • 通讯作者: 张凡，副主任医师，解放军成都军区总医院肾脏内科，四川省成都市 610083 weimengwm@sina.com
  • 作者简介:王涛，女，1968年生，四川省达州市人，汉族，1991年华西医科大学毕业，副主任医师，主要从事肾脏病的相关研究。 wangtaozyy@gmail.com

Anatomical snuffbox versus forearm internal arteriovenous fistula for 214 hemodialysis patients with chronic renal failure: Which is the better method for permanent vascular access prior to kidney transplantation

Wang Tao, Guo Dong-yang, Wei Meng, Wang Ying, Zhang Fan   

  1. Department of Nephrology, General Hospital of Chengdu Military Area Command of Chinese PLA, Chengdu   610083, Sichuan Province, China
  • Online:2010-07-30 Published:2010-07-30
  • Contact: Zhang Fan, Associate chief physician, Department of Nephrology, General Hospital of Chengdu Military Area Command of Chinese PLA, Chengdu 610083, Sichuan Province, China weimengwm@sina.com
  • About author:Wang Tao, Associate chief physician, Department of Nephrology, General Hospital of Chengdu Military Area Command of Chinese PLA, Chengdu 610083, Sichuan Province, China wangtaozyy@gmail.com

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摘要：

背景：肾移植前采用前臂头静脉和桡动脉成功建立动静脉内瘘可成为维持血液透析良好的血管通路。
目的：比较鼻烟窝和前臂动静脉内瘘在血液透析中的临床效果。
方法：将214例慢性肾功能衰竭患者以抽签法随机分为鼻烟窝组(n=118)和前臂组(n=96)，分别建立鼻烟窝和前臂动静脉内瘘，观察比较两组手术成功率、内瘘成熟时间、血流量、近远期内瘘通畅率及并发症的发生率。
结果与结论：两组在手术成功率、内瘘成熟时间、和血流量上差异均无显著性意义(P > 0.05)。两组近期内瘘通畅率虽无显著差异，但鼻烟窝组两三年远期通畅率显著高于前臂组(P < 0.05)。并且鼻烟窝组假性动脉瘤发生率及充血性心力衰竭的发生率显著低于前臂组(P < 0.05)。两组均未发生切口感染、肿胀综合征及窃血综合征 (P > 0.05)。与前臂动静脉内瘘相比，鼻烟窝动静脉内瘘建立更简单，远期通畅率更高，并发症较少，使用时间更长，是肾移植前血液透析首选的永久性血管通路。

关键词: 慢性肾功能不全, 动静脉内瘘, 血液透析, 鼻烟窝, 血管通路

Abstract:

BACKGROUND: Internal arteriovenous fistula of cephalic vein and radial artery in forearm is a necessary vascular access in hemodialysis before kidney transplantation.
OBJECTIVE: To compare the clinical effect between anatomical snuffbox and forearm internal arteriovenous fistula in hemodialysis.
METHODS: A total of 214 patients with chronic renal failure were randomly divided into snuffbox (n=118) and forearm internal arteriovenous fistula (n=96) groups, respectively underwent internal arteriovenous fistula at anatomical snuffbox and distal forearm. Success rate of operation, time of maturation, volume of blood flow, patency rate of short-term and long-term, and complications in two groups were observed and compared.
RESULTS AND CONCLUSION: There were no significant differences between two groups in success rate of operation, time of mature, and volume of blood flow (P > 0.05). The patency rates in snuffbox and forearm groups were similar in short-term periods, but the patency rate was significantly greater in snuffbox group than forearm group at 2-3 years (P < 0.05), and the incidence rates of pseudoaneurysm and congestive heart failure in snuffbox group were significantly less than the forearm group (P < 0.05). Moreover, there were no significant differences in incidence rates of symptom swelling syndrome and steal syndrome between two groups (P > 0.05). Compared with forearm internal arteriovenous fistula, anatomical snuffbox internal arteriovenous fistula should be the first-chosen permanent vascular access in hemodialysis due to easier establishment, higher long-term patency rates, fewer complications and longer service life.

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