目的 探讨维持血液透析患者建立血管通路的各种术式的临床应用和选择。 方法 采用各种术式为322例维持血液透析患者建立血管通路，术前根据血管条件进行术式选择，观察手术用时、成功率、内瘘成熟时间、血液透析时平均血流量等指标及并发症发生率。 结果 322例患者共进行动静脉内瘘手术380例次。鼻烟窝内瘘39例次，通畅率92.3%；前臂标准内瘘280例次，通畅率92.9%；PTFE人造血管襻式和直形内瘘分别45和7例次，通畅率98.1%；4例患者最终无法建立内瘘。 结论 各种术式应用中各有优劣，应根据患者具体条件选择手术方式。这些方法相互补充可延长的血管通路维持时间。

Objective To investigate the clinical application and the choice of operation pattern for arteriovenous fistula (AVF) in hemodialysis patients. Methods AVFs of various operation patterns were established in 322 hemodialysis patients. The AVF pattern depended on the vascular condition before the operation. Time span for operation manipulation, successful rate, duration for AVF maturation, average blood flow during dialysis, and complications were compared among AVFs of various operation patterns. Results A total of 380 AVF operations were performed in the 322 patients, of which 39 cases had snuffbox fistulas with the patency rate of 92.3%, 280 cases had forearm typical fistulas with the patency rate of 92.9%, 52 cases contained artificial graft fistulas with the patency rate of 98.1%, and 4 cases failed to establish an AVF. Conclusion Every operation pattern of AFV has advantages as well as disadvantages. The choice of AFV operation pattern depends on patient’s vascular condition. Appropriate selection of AVF operation pattern will extend the vascular access function.