关键词:

维持性透析, 血管通路, 自体动静脉内瘘, 尺动脉-贵要静脉内瘘

Abstract:

Objective By comparing the application effects of ulnar⁃basilic arteriovenous fistula（observa⁃ tion group）and radial⁃cephalic arteriovenous fistula （control group），explore its application value in the long⁃term dialysis treatment of patients with end⁃stage renal disease. Methods Retrospective analysis was performed on the clinical data of 154 patients who underwent arteriovenous fistula in the Department of Nephrology of the Affiliated Hospital of Jiangsu University from January 2018 to May 2019（10 cases of ulnar⁃basilic arteriovenous fistula and 144 cases of radial ⁃ cephalic arteriovenous fistula）. The patients were followed up for 2 years. The differences of maturation time，infection rate，complication rate，primary patency rate and secondary patency rate as of 1，6，12 and 24 months between the two surgical methods were analyzed statistically. Results There were no significant differences in primary diabetic nephropathy，age，gender composition，and peripheral vascular disease between the two groups（P > 0.05）. All patients had successful internal fistula surgery，and there were no major vascular and nerve damage or hemorrhage during the operation. The internal fistula was unobstructed，and the blood vessel murmur was clear. There were no internal fistula infections，swollen hands，internal fistula limbs stealing blood， and cardiac insufficiency in the postoperative follow ⁃ up. The average maturity time of the observation group was （37.00 ± 13.40）days，and the average maturity time of the control group was（30.00 ± 2.00）days. There was a statistically significant difference in the average maturity time between the two groups（t = 6.227，P < 0.001）. In regard of complications，there was 1 case of pseudoaneurysm in the observation group while 1 case of tumor ⁃likedilatation occurred in the control group. The primary patency rates in the observation group as of 1，6，12 and 24 months was respectively 70% ，60% ，60% ，60% . While in the control group they were respectively 98.61% ， 96.13%，92.36%，88.19%. The primary patency rate was significantly different between the two groups（χ2 = 9.902， P = 0.002）. The secondary patency rates in the observation group as of 1，6，12 and 24 months were respectively 80%，80%，70%，and 70%. In the observation group，the secondary patency rate at 1，6，12 and 24 months was 80%， 80%，70%，70%，respectively，while in the control group，the secondary patency rate at 1，6，12 and 24 months was 98.61%，97.22%，96.53%，96.53% . There was significant difference in secondary patency between the two groups （χ2 = 21.32，P < 0.001）. Conclusion The surgical infection rate and complication rate of ulnar⁃basilic arteriove⁃ nous fistula were low. But compared with the radial⁃cephalic arteriovenous fistula ，the primary patency rate and secondary patency rate of 1 month，6 months，12 months and 24 months were lower，and the maturation time was relatively longer. Therefore，it could be used as a secondary option under certain conditions.

Key words:

maintenance dialysis, vascular access, arteriovenous fistula, ulnar ? basilic arteriove? nous fistula