No-touch技术在腕部标准动静脉内瘘中的应用

    Application of No-touch technique in wrist standard arteriovenous fistula

    • 摘要:
      目的 探讨No-touch技术分离头静脉建立腕部标准动静脉内瘘(SAVF)的临床应用。
      方法 回顾性分析95例行左或右前臂SAVF手术以维持长期透析病人的临床资料。依据静脉分离方法分为No-touch技术组(N组)50例和传统技术组(T组)45例, 比较2组观察期内手术成功率、临床成功率及并发症发生情况。
      结果 观察期内2组术后手术成功率均为100.0%。T组短期内出现前臂水肿病例数明显多于N组(P<0.01), 2组短期内出现渗血、疼痛、血管痉挛病例数差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析显示, 至随访期结束, N组的临床成功率为84.0%(42/50), 明显高于T组的60.0%(27/45)(P<0.01);Log-Rank检验显示, N组临床成功率优于T组(P<0.05)。N组Ⅰ型狭窄和内瘘发育不良发生率低于T组(P<0.05), 2组其他型狭窄、发育不良和其他原因闭塞例数差异均无统计学意义(P>0.05)。
      结论 使用No-touch技术分离头静脉建立SAVF, 可明显降低Ⅰ型狭窄的发生率, 提高手术临床成功率, 该方法值得临床推广应用。

       

      Abstract:
      Objective To investigate the clinical application of No-touch technique in the establishment of wrist standard arteriovenous fistula(SAVF) by cephalic vein separation.
      Methods: The clinical data of 95 patients undergoing left or right forearm SAVF surgery to maintain long-term dialysis were analyzed retrospectively.According to the method of vein separation, 50 cases were set as No-touch technique group(group N) and 45 cases were set as traditional technique group(group T).The operation success rate, clinical success rate and complications were compared between the two groups during the follow-up period.
      Results: During the follow-up period, the operation success rate in the two groups was 100.0%.The number of forearm edema cases of short-term complications in group T was significantly higher than that in group N(P < 0.01), and there was no significant difference in the number of bleeding, pain and vasospasm cases between the two groups(P>0.05).Kaplan-Meier survival analysis showed that in group N was 84.0%(42/50), which was significantly higher than 60.0%(27/45) in group T at the end of the follow-up period(P < 0.01), and Log-Rank test showed that the clinical sows nate in the clinical success rate in group N was better than group T(P < 0.05).The incidence of type Ⅰ stenosis and dysplasia of internal fistula in group N was lower than that in group T(P < 0.05), and there was no significant difference in the number of other types of stenosis, dysplasia and other cause-induced occlusion between the two groups(P>0.05).
      Conclusions: It can significantly reduce the incidence of type Ⅰ stenosis and improve the clinical success rate of operation to apply No-touch technique to separate cephalic vein for SAVF establishment, which is worthy of clinical application.

       

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