自体动静脉内瘘成形术中三种不同血管缝合方式的临床研究(1)
[摘要] 目的 观察自体动静脉内瘘成形术中连续缝合法、连续-间断缝合法与间断缝合法三種不同血管缝合方式的临床效果，以期进一步提高动静脉内瘘手术成功率。 方法 选取南京市中心医院外科2015月9月～2017年5月行自体动静脉内瘘成形术患者98例，按照简单随机分组法将其分为三组，在相同手术条件下分别行连续缝合(32例)、连续-间断缝合(33例)、间断缝合(33例)。比较三组患者的一次性吻合成功率和术后24 h、3个月、6个月瘘管通畅率，以及术后1、3、6个月的吻合口直径及内瘘血流量变化，并对相关数据做统计学处理。 结果 三组患者的一次性吻合成功率比较，差异有统计学意义(P < 0.05)。连续-间断缝合组一次性吻合成功率高于连续缝合组的一次性吻合成功率与间断缝合组，差异均有统计学意义(P < 0.05)。术后3、6个月的瘘管通畅率连续-间断缝合组均高于连续缝合组，差异均有统计学意义(P < 0.05)；术后24 h、3个月、6个月的瘘管通畅率间断缝合组患者均高于连续缝合组，差异均有统计学意义(P < 0.05)；三组患者的瘘管通畅率总体比较，差异有高度统计学意义(P < 0.01)。术后1、3、6个月的吻合口直径连续-间断缝合组和间断缝合组均长于连续缝合组(P < 0.01)；术后1、6个月的吻合口直径间断缝合组患者均长于连续-间断缝合组(P < 0.05)；三组患者的吻合口直径总体比较，差异有高度统计学意义(P < 0.01)。术后1、3、6个月的内瘘血流量连续-间断缝合组均高于连续缝合组(P < 0.05)；术后1、6个月的内瘘血流量间断缝合组均高于连续-间断缝合组和连续组内瘘血流量(P < 0.05)；术后1、3、6个月三组间的动静脉内瘘血流量比较，差异有高度统计学意义(P < 0.01)。 结论 连续-间断缝合法将连续缝合法和间断缝合法相结合，兼有两者的优点，是一种良好的动静脉内瘘血管吻合技术。
[关键词] 动静脉内瘘；缝合方式；连续缝合；间断缝合；连续-间断缝合
[中图分类号] R692.5 [文献标识码] A [文章编号] 1673-7210(2018)09(a)-0083-05
[Abstract] Objective To improve the success rate of arteriovenous fistula operation by studying the clinical effect of three different vascular suturation techniques： continuous suture，continuous-discontinuous suture and discontinuous suture. Methods A total of 98 patients that underwent autogenous arteriovenous fistula operation in Nanjing Central Hospital from September 2015 to May 2017 were selected. In the same operation condition， they were randomly divided into three groups according to different vascular suturation technique： continuous suture group (32 cases)， continuous-discontinuous suture group (33 cases) and discontinuous suture group (33 cases). Then， the one-time success rate of operation， the fistula patency rate postoperative 24 hours， 3 months， 6 months， the diameter of anatomosis and the blood flow change of fistula postoperative 1 month， 3 months， 6 months were compared among the three groups， and statistical analysis was made to analyze the data. Results The one-time success rate of operation among the three groups had statistically significant difference (P < 0.05). The one-time success rate of continuous-discontinuous suture group was higher than those of continuous suture group and discontinuous suture group that had statistically significant differences (P < 0.05). The fistula patency rate in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 3 months and 6 months (P < 0.05). The fistula patency rate in the discontinuous suture group was higher than the continuous suture group postoperative 24 hours， 3 months and 6 months (P < 0.05). The fistula patency rate had difference among the three groups (P < 0.05). The diameter of anatomosis in the continuous-discontinuous suture group and discontinuous suture group were longer than the continuous suture group postoperative 1， 3 and 6 months (P < 0.01)； the diameter of anatomosis in the discontinuous suture group was longer than the continuous-discontinuous suture group postoperative 1 month and 6 months (P < 0.05)； the diameter of anatomosis among the three groups had high statistically significant difference (P < 0.01). The blood flow of fistula in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 1， 3 and 6 months (P < 0.05)； the blood flow of fistula in discontinuous suture group was higher than the other two groups postoperative 1 month and 6 months (P < 0.05)； the blood flow of fistula among the three groups postoperative 1， 3， 6 months had statistically significant difference (P < 0.01). Conclusion The continuous-discontinuous suture is a good suturation manner that combines the advantages of continuous suture and discontinuous suture， and it is a good technique for vascular anastomosis in internal arteriovenous fistula., http://www.100md.com(欧阳彬 张海峰 潘宁丰)
[关键词] 动静脉内瘘；缝合方式；连续缝合；间断缝合；连续-间断缝合
[中图分类号] R692.5 [文献标识码] A [文章编号] 1673-7210(2018)09(a)-0083-05
[Abstract] Objective To improve the success rate of arteriovenous fistula operation by studying the clinical effect of three different vascular suturation techniques： continuous suture，continuous-discontinuous suture and discontinuous suture. Methods A total of 98 patients that underwent autogenous arteriovenous fistula operation in Nanjing Central Hospital from September 2015 to May 2017 were selected. In the same operation condition， they were randomly divided into three groups according to different vascular suturation technique： continuous suture group (32 cases)， continuous-discontinuous suture group (33 cases) and discontinuous suture group (33 cases). Then， the one-time success rate of operation， the fistula patency rate postoperative 24 hours， 3 months， 6 months， the diameter of anatomosis and the blood flow change of fistula postoperative 1 month， 3 months， 6 months were compared among the three groups， and statistical analysis was made to analyze the data. Results The one-time success rate of operation among the three groups had statistically significant difference (P < 0.05). The one-time success rate of continuous-discontinuous suture group was higher than those of continuous suture group and discontinuous suture group that had statistically significant differences (P < 0.05). The fistula patency rate in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 3 months and 6 months (P < 0.05). The fistula patency rate in the discontinuous suture group was higher than the continuous suture group postoperative 24 hours， 3 months and 6 months (P < 0.05). The fistula patency rate had difference among the three groups (P < 0.05). The diameter of anatomosis in the continuous-discontinuous suture group and discontinuous suture group were longer than the continuous suture group postoperative 1， 3 and 6 months (P < 0.01)； the diameter of anatomosis in the discontinuous suture group was longer than the continuous-discontinuous suture group postoperative 1 month and 6 months (P < 0.05)； the diameter of anatomosis among the three groups had high statistically significant difference (P < 0.01). The blood flow of fistula in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 1， 3 and 6 months (P < 0.05)； the blood flow of fistula in discontinuous suture group was higher than the other two groups postoperative 1 month and 6 months (P < 0.05)； the blood flow of fistula among the three groups postoperative 1， 3， 6 months had statistically significant difference (P < 0.01). Conclusion The continuous-discontinuous suture is a good suturation manner that combines the advantages of continuous suture and discontinuous suture， and it is a good technique for vascular anastomosis in internal arteriovenous fistula., http://www.100md.com(欧阳彬 张海峰 潘宁丰)