目的 探讨侧侧吻合技术对终末期肾病(end-stage renal disease，ESRD)血液透析(hemodialysis，HD)患者建立前臂自体动静脉内瘘(arteriovenous fistula，AVF)功能的影响。 方法 选取2019年5月─2021年9月于潍坊市人民医院肾脏病医学中心行前臂AVF手术的患者，根据血管吻合技术不同分为端侧吻合的AVF(端侧吻合组)及侧侧吻合的AVF(侧侧吻合组)。比较2组患者的手术成功率、手术后并发症差异。COX回归分析多因素与AVF通畅时间的关系。采用Kaplan-Meier生存分析法分析总体人群及不同组间的初级通畅率、累积通畅率。 结果 共纳入218例患者，端侧吻合组123例，侧侧吻合组95例。2组手术成功率(χ2=0.017，P=0.897)、手术后8周时AVF中位血流量(Z=-1.820，P=0.069)及手术后严重肢体肿胀发生率(P=0.189)的差异无统计学意义。多因素COX比例风险回归模型分析显示：女性对AVF累积通畅时间有负面影响(HR=4.603，95% CI:1.548～13.770，P=0.006)，而AVF侧侧吻合方式较端侧吻合方式对累积通畅时间有正面影响(HR=0.307,95% CI:0.112～0.845，P=0.022)。总体患者的AVF的初级通畅率在12、24个月时分别为73.9%，57.9%，累积通畅率分别为95.2%，87.7%。2组间初级通畅率差异无统计学意义(χ2=2.816，P=0.093)、累积通畅率差异有统计学意义(χ2=4.172，P=0.041)。 结论 前臂近端桡动脉-头静脉侧侧吻合内瘘对于远端血管条件差的HD患者提供了安全有效的手术方式，无严重并发症，与端侧吻合相比显示出较好的累积通畅性。
Objective To investigate the effect of side-to-side anastomosis technique on the function of forearm autologous arteriovenous fistula (AVF) in end-stage renal disease (ESRD) patients with hemodialysis (HD). Methods Patients undergoing forearm AVF surgery at the Kidney Disease Medical Center of Weifang People's Hospital from May 2019 to September 2021 were enrolled in this study. They were divided into two groups based on the vascular anastomosis technique, end-to-side anastomosis group and side-to-side anastomosis group. Surgical success rate and postoperative complications were compared between the two groups. COX regression was used to analyze the relationship between various factors and AVF patency. Kaplan-Meier survival analysis was used to analyze the primary patency rate and cumulative patency rate in overall patients and the two groups. Results A total of 218 patients were included, with 123 in the end-to-side anastomosis group and 95 in the side-to-side anastomosis group. There were no statistical differences in surgical success rate (χ2=0.017, P=0.897), median AVF blood flow after the operation for 8 weeks (Z=-1.820, P=0.069), and postoperative severe limb swelling (P=0.189) between the two groups. Multifactorial COX proportional risk regression model analysis showed that female was a negative factor for AVF cumulative patency (HR=4.603, 95% CI:1.548～13.770, P=0.006), and AVF side-to-side anastomosis was a positive factor for AVF cumulative patency period as compared with that of end-to-side anastomosis (HR=0.307, 95% CI:0.112～0.845, P=0.022). In overall patients after the operation for 12 and 24 months, the primary AVF patency rates were 73.9% and 57.9% respectively, and the cumulative patency rates were 95.2% and 87.75 respectively. AVF cumulative patency rate was statistically different between the two groups (χ2=4.172, P=0.041), while AVF primary patency rate had no statistical difference (χ2=2.816, P=0.093). Conclusion Side-to-side anastomosis for constructing forearm proximal radial-cephalic AVF is a safe and effective operation for HD patients, with better cumulative patency than that of end-to-side anastomosis technique.
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