【摘要】目的研究基于对人工血管动静脉内瘘(arteriovenous graft, AVG)流出道选择的不同，探讨其术后近期通畅率及相关影响因素。方法将新疆维吾尔自治区人民医院血管外科2017 年6 月～2019 年6 月收治的终末期肾病拟行AVG 患者纳入研究对象。收集患者临床资料，以人工血管流出道是浅静脉或是深静脉作为分组标准，通过t 检验和卡方检验比较2 组患者的一般资料及术中资料；通过Kaplan-Meier 对比2 组患者术后6 个月内的通畅率；通过COX 模型分析其相关危险因素。结果纳入研究对象37 例，将流出道为浅静脉的患者分为A 组(头静脉、贵要静脉、肘正中静脉，共22 例)；将流出道为深静脉的患者分为B 组(肱静脉，共15 例)。2 组患者的一般资料及术中资料，仅人工血管规格差异具统计学意义(X2=17.357，P=0.002)；2 组患者术后6 个月内通畅率无明显差异(X2= 0.224，P=0.636)；COX 回归分析对手术位置、性别、移植物型号、分组(A 组比B 组)相关因素分析差异均无统计学意义(OR 值分别为1.265，1.668，3.936，1.880；95% CI 值分别为0.241～6.626，0.315～8.821，0.657～23.590，0.398～8.881；P 值分别为0.781，0.547，0.781，0.426)。结论AVG 远端流出道选用深静脉或是浅静脉，术后近期通畅率无明显差异。
【Abstract】Objective To investigate the effect of different outflow tract selection on short-term patency rate of the artificial arteriovenous graft (AVG) and its related factors. Methods The end-stage renal disease patients treated in the Department of Vascular Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region for AVG operation during the period from June 2017 to June 2019 were enrolled in this study. Their clinical data were collected. They were divided into group A (n=22) in which superficial veins were used for the outflow tract of AVG, and group B (n=15) in which a deep vein was used for the outflow tract of AVG. The general information and intraoperative data were compared between the two groups and analyzed by t-test and chi square test; the patency rate within 6 months after operation was compared between the two groups and analyzed by Kaplan-Meier survival method; the related risk factors were evaluated by Cox model. Results A total of 37 cases were enrolled in this study. Cephalic vein, basilic vein or median cubital vein was used as the outflow tract of AVG in group A, and the deep vein of brachial vein was used as the outflow tract of AVG in group B. There were no significant differences in general information and intraoperative data between the two groups, except that the type of artificial blood vessels was different (χ2=17.357, P=0.002). There was no significant difference in patency rate within 6 months after operation between the two groups (χ2=0.224, P=0.636). Cox model showed that operation site, gender, graft type, and group A or B were unrelated to the short-term patency rate of AVG (OR=1.265, 1.668, 3.936 and 1.880 respectively; 95% CI=0.241~6.626, 0.315~8.821, 0.657~23.590 and 0.398~8.881 respectively; P=0.781, 0.547, 0.781 and 0.426 respectively). Conclusion The short-term patency rate of the AVG was similar, whether superficial vein or deep vein was used for the outflow tract of AVG. However, large clinical samples are required to confirm this conclusion.
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