改良的功能性端侧吻合对前臂远端桡-头动静脉内瘘近吻合口静脉狭窄及功能的影响

doi:10.3969/j.issn.1006-298X.2025.02.005

肾脏病与透析肾移植杂志 ›› 2025, Vol. 34 ›› Issue (2): 126-132.DOI: 10.3969/j.issn.1006-298X.2025.02.005

改良的功能性端侧吻合对前臂远端桡-头动静脉内瘘近吻合口静脉狭窄及功能的影响

出版日期:2025-04-28 发布日期:2025-05-07

Modified functional end-to-side anastomosis on venous juxta-anastomotic stenosis and function of distal forearm radiocephalic arteriovenous fistula

Online:2025-04-28 Published:2025-05-07

摘要/Abstract

摘要： 目的：评估应用改良的功能性端侧吻合(MFETS)建立前臂远端桡-头动静脉内瘘(RC-AVF)对内瘘近吻合口静脉狭窄(VJAS)及功能的影响。
方法：选取2022年7月至2023年4月在济宁医学院附属日照市人民医院血液净化科首次实施前臂远端RC-AVF手术的患者,根据前臂远端RC-AVF建立方法的不同分为头静脉端与桡动脉侧的常规端侧吻合(CETS)组及MFETS组。比较两组患者术后12月内的内瘘VJAS发生率、内瘘功能及内瘘近吻合口静脉血流性质。
结果：共纳入102例患者,CETS组59例,MFETS组43例。术后12月内,经Kaplan-Meier生存分析和log-rank检验,MFETS组内瘘未发生VJAS的概率高于CETS组(χ2=4.539,P=0.033);MFETS组内瘘未发生成熟不良的概率亦高于CETS组(χ2=4.347,P=0.037);MFETS组内瘘通畅率优于CETS组(χ2=5.231,P=0.022)。彩色多普勒结果提示,CETS组近吻合口静脉血流动力学紊乱重于MFETS组,CETS组呈湍流状态,MFETS组呈螺旋层流状态。
结论：与CETS比较,应用MFETS构建前臂远端RC-AVF能够减轻内瘘近吻合口静脉血流动力学紊乱,降低内瘘VJAS发生率,并提高内瘘通畅率。

关键词: 动静脉内瘘, 改良的功能性端侧吻合, 常规端侧吻合, 近吻合口静脉狭窄

Abstract: Ｏｂｊｅｃｔｉｖｅ：To evaluate the effect of modified functional end-to-side anastomosis(MFETS)on venous juxta-anastomotic stenosis(VJAS)and function of distal forearm radiocephalic arteriovenous fistula(RC-AVF).
Ｍｅｔｈｏｄｏｌｏｇｙ：A retrospective cohort study was conducted. Patients who underwent distal forearm RC-AVF surgery for the first time in the Department of Blood Purification, the People’s Hospital of Rizhao Affliated to Jining Medical College, from July 2022 to April 2023, were divided into the conventional end-to-side anastomosis(CETS)group and MFETS group according to the different methods of RC-AVF creation. The incidence of the VJAS, the function of RC-AVF and the blood flow properties in juxta-anastomotic vein within 12 months after surgery were compared between the two groups.
Ｒｅｓｕｌｔｓ：A total of 102 patients were included, 59 in the CETS group and 43 in the MFETS group. Within 12 months after surgery,Kaplan-Meier survival analysis and log-rank test showed that the probability of no VJAS in the MFETS group was higher than that in the CETS group(Log-Rank χ2=4.539, P=0.033), the probability of no immature fistula in the MFETS group also higher than that in CETS group(Log-Rank χ2=4.347, P=0.037), and the postoperative patency rate of the fistula in MFETS group better than that in CETS group(Log-Rank χ2=5.231, P=0.022). Color Doppler results showed the hemodynamic disturbance of the juxta-anastomotic veins in CETS group was more serious than that in MFETS group. The blood flow of in CETS group was in a turbulent state, and the blood flow in MFETS group in a spiral laminar flow state.
Ｃｏｎｃｌｕｓｉｏｎ：Compared with applying CETS, applying MFETS in the creation of distal forearm RC-AVF could decrease the hemodynamic disturbance of the juxta-anastomotic cephalic veins, reduce the incidence of the VJAS and improve the patency rate of the RC-AVF.

Key words: arteriovenous fistula, modified functional end-to-side anastomosis, conventional end-to-side anastomosis, venous juxta-anastomotic stenosis

牟文清, 安传国, 陈朝进, 李凤楼, 诸葛祥娣, 邸鹏飞, 付海霞, 焦自钊. 改良的功能性端侧吻合对前臂远端桡-头动静脉内瘘近吻合口静脉狭窄及功能的影响[J]. 肾脏病与透析肾移植杂志, 2025, 34(2): 126-132.

MU Wenqing, AN Chuanguo, CHEN Chaojin, LI Fenglou, ZHUGE Xiangdi, DI Pengfei, FU Haixia, JIAO Zizhao. Modified functional end-to-side anastomosis on venous juxta-anastomotic stenosis and function of distal forearm radiocephalic arteriovenous fistula[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2025, 34(2): 126-132.

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ISSN 1006-298X CN 32-1425/R

改良的功能性端侧吻合对前臂远端桡-头动静脉内瘘近吻合口静脉狭窄及功能的影响

Modified functional end-to-side anastomosis on venous juxta-anastomotic stenosis and function of distal forearm radiocephalic arteriovenous fistula

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