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目的探讨彩超在尿毒症患者自体动静脉内瘘建立中的应用价值。方法回顾性分析2010年9月至2016年9月在西南医院肾科行自体动静脉内瘘手术的1 895例尿毒症患者的临床资料,其中男性984例,女性911例,年龄18~79岁,平均57.2岁。根据其术前有无彩超检查定位分为物理检查组及超声检查组,比较两组手术时间及切口大小、手术一次性成功率、术前定位与最终手术部位匹配率、术后1周内瘘闭塞率、术后1个月内瘘成熟率及2个月后内瘘可穿刺率。结果超声检查组手术一次性成功率为95.8%,术前定位与最终手术部位匹配率为99.7%,2个月后内瘘可穿刺率99.8%,均明显高于物理检查组(P<0.05);手术时间为(63±18)min、手术切口为(3.1±0.4)cm,术后1周内瘘闭塞率3.9%,均明显低于物理检查组(P<0.05);术后1个月内瘘成熟率因物理检查组未常规检查无法比较。结论彩超可显著提高尿毒症患者自体动静脉内瘘手术一次性成功率、减小手术切口、缩短手术时间、降低早期闭塞率,并且通过术后的早期监测可及时发现内瘘相关并发症。
Objective To investigate the value of color Doppler ultrasonography in the establishment of autogenous arteriovenous fistula in patients with uremia. Methods The clinical data of 1895 uremic patients with autologous arteriovenous fistula in the Department of Nephrology, Southwest Hospital from September 2010 to September 2016 were retrospectively analyzed. There were 984 males and 911 females, aged 18-79 years , An average of 57.2 years old. According to their non-color and ultrasonographic preoperative positioning is divided into physical examination group and ultrasound examination group, comparing the two groups of operation time and incision size, the success rate of one-time operation, preoperative positioning and the final surgical site matching rate, 1 week after the fistula Occlusion rate, the rate of fistula maturation within 1 month and the rate of fistula puncture after 2 months. Results The success rate of one-off operation was 95.8% in the ultrasound group, 99.7% in the preoperative location and the final operation site, and 99.8% in the fist month after 2 months, which were significantly higher than those in the physical examination group (P <0.05) The operative time was 63 ± 18 min, the incision was (3.1 ± 0.4) cm, and the occlusion rate was 3.9% within 1 week after operation, which were significantly lower than those in the physical examination group (P <0.05) The fistula maturation rate can not be compared due to unconventional examination of the physical examination group. CONCLUSION: Color Doppler ultrasound can significantly improve the one-time success rate of autologous arteriovenous fistula in patients with uremia, reduce the surgical incision, shorten the operation time and reduce the rate of early occlusion. Fistula-related complications can be detected in time by early postoperative monitoring.