• 樂(lè)山市人民醫(yī)院普外科（四川樂(lè)山，614004）;

【摘要】　目的　 評(píng)價(jià)在鼻煙壺及腕部行動(dòng)靜脈造瘺術(shù)的療效。　方法　 將2007年6月-2009年6月收治的156例腎功能衰竭患者隨機(jī)分成兩組，分別在鼻煙壺及腕部行動(dòng)靜脈造瘺術(shù)，術(shù)后經(jīng)彩色超聲隨訪其吻合口通暢情況，臨床觀察瘺管使用時(shí)間及其并發(fā)癥。　結(jié)果　 術(shù)后隨訪2年，鼻煙壺處行動(dòng)靜脈造瘺術(shù)的患者，瘺管術(shù)后1年初級(jí)通暢率及累積次級(jí)通暢率分別為76.9%、92.1%；術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率分別為57.9%、78.9%。而腕部組瘺管1年初級(jí)通暢率及累積次級(jí)通暢率分別為64.1%、81.3%；術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率分別為56.0%、76.0%。兩組在術(shù)后1年初級(jí)通暢率及累積次級(jí)通暢率差異有統(tǒng)計(jì)學(xué)意義（P lt;0.01），術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）。　結(jié)論　 鼻煙壺處行動(dòng)靜脈造瘺術(shù)的瘺管在短期內(nèi)通暢率較腕部高，長(zhǎng)期并無(wú)顯著性差異。
【Abstract】　Objective　 To evaluate the effect of artificial arteriovenous fistula between tabatiere anatomique and wrist.　Methods　 From June 2007 to June 2009, 156 cases of renal failure were randomly divided into two groups, and underwent artificial arteriovenous fistula on tabatiere anatomique or wrist, respectively. The patency of the anastomotic stoma was observed via B ultrasonography.　Results　 The patients were followed up for two years postoperative. After the operation, the primary patency was 76.9% at the first year and 57.9% at the second year in tabatiere anatomique group; cumulative secondary patency was 92.1% at the first year and 78.9% at the second in tabatiere anatomique group; primary patency was 64.1% at the first year and 56.0% at the second in wrist group; cumulative secondary patency was 81.3% at the first year and 76.0% at the second year in wrist group. The primary patency and cumulative secondary patency were significantly different between tabatiere anatomique group and wrist group at the first year postoperatively (P lt;0.01) and not significant at the second year postoperatively (P gt;0.05).　Conclusion　 Prophase patency of tabatiere anatomique is higher than that of wrist. There was no significant difference between them in a long term.

引用本文： 俞慎林,雷澤華,高峰畏. 動(dòng)靜脈造瘺在鼻煙壺及腕部的臨床研究. 華西醫(yī)學(xué), 2011, 26(11): 1669-1671. doi: 復(fù)制

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11. 　Gauly A, Parisotto MT, Skinder A, et al. Vascular access cannulation in hemodialysis patients-a survey of current practice and its relation to dialysis dose[J]. J Vasc Access, 2011, 13(3): 184-195.
12. 　Al Saran K, Sabry A, Hassan AH, et ai. Evaluation of quality of care in a large Saudi Hemodialysis Center[J]. Ren Fail, 2011, 33(6): 555-561.
13. 　Reinhold C, Haage P, Hollenbeck M, et al. Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis[J]. Vasa, 2011, 40(3): 188-198.
  1. 1. 　Iyem H. Early follow-up results of arteriovenous fistulae created for hemodialysis[J]. Vasc Health Risk Manag, 2011, 7(5): 321-325.
  2. 2. 　Vesquez PO, Marco MM, Mandersson B. Arteriovenous fistula stenosis detection using wavelets and support vector machines[J]. Conf Proc IEEE Eng Med Biol Soc, 2009, 25(10): 1298-1301.
  3. 3. 　Weyde W, Krajewska M, Klinger M. Vascular access for hemodialysis in difficult patients——procedure principles based on own experiences[J]. Pol Merkur Lekarski, 2006, 21(12): 142-143.
  4. 4. 　Zhong WQ, Yang TC, Yu LQ. Clinical research on arteriovenous internal fistula made by various blood vessels[J]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 2000, 14(1): 4-6.
  5. 5. 　Srivastava A, Sharma S. Hemodialysis vascular access options after failed Brescia-Cimino arteriovenous fistula[J]. ndian J Urol, 2011, 27(2): 163-168.
  6. 6. 　Paulson KA, Gordon V, Flynn L, et al. Modified two-stage basilic vein transposition for hemodialysis access[J]. Am J Surg, 2011, 202(2):184-187.
  7. 7. 　葉朝陽(yáng). 血液透析血管通路的理論及實(shí)踐[M]. 上海: 復(fù)旦大學(xué)出版社, 2001: 237-252.
  8. 8. 　Allon M, Litovsky S, Young CJ, Deierhoi MH.Medial Fibrosis, Vascular Calcification, Intimal Hyperplasia, and Arteriovenous Fistula Maturation[J]. Am J Kidney Dis, 2011, 29(3): 172-175.
  9. 9. 　Huber TS, Carter JW, Carter RL, et al. Patency of autogenous and polytetrafluoroethylene upper etremity arteriovenous hemodialysis accessed;a systematic review[J]. J Vasc Surg, 2008, 38(12): 1005-1011.
  10. 10. 　Monroy-Cuadros M, Yilmaz S, Salazar-Bauelos A, et al. Independent prediction factors for primary patency loss in arteriovenous grafts within six months[J]. J Vasc Access, 2010, 28(15): 1425-1435.
  11. 11. 　Gauly A, Parisotto MT, Skinder A, et al. Vascular access cannulation in hemodialysis patients-a survey of current practice and its relation to dialysis dose[J]. J Vasc Access, 2011, 13(3): 184-195.
  12. 12. 　Al Saran K, Sabry A, Hassan AH, et ai. Evaluation of quality of care in a large Saudi Hemodialysis Center[J]. Ren Fail, 2011, 33(6): 555-561.
  13. 13. 　Reinhold C, Haage P, Hollenbeck M, et al. Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis[J]. Vasa, 2011, 40(3): 188-198.