目的 观察应用桡动脉表浅化移位的功能性端侧吻合(functional end-to-side anastomosis with radial artery superficial displacement,FETSRAS)技术构建前臂远端桡动脉-头静脉内瘘(radiocephalic arteriovenous fistula,RC-AVF)对内瘘成熟的影响。 方法 选取2020年3月—2022年6月在日照市人民医院血液净化科首次实施前臂远端RC-AVF手术的患者为研究对象，根据RC-AVF建立方法的不同分为头静脉端与桡动脉侧的常规端侧吻合(conventional end-to-side anastomosis,CETS)组及FETSRAS组。手术后随访12周，应用临床血管检查、彩色多普勒超声血管检查及内瘘泵控血流量评估2组内瘘的成熟情况。 结果 共纳入121例前臂远端RC-AVF手术患者，其中CETS组64例，FETSRAS组57例。手术后第6周、12周FETSRAS组临床内瘘成熟率分别为80.7%、89.5%，高于CETS组的64.1%、73.4%(χ2=4.132、5.036，P=0.042、0.025)；手术后第6周、12周FETSRAS组影像学内瘘成熟率分别为86.0%、93.0%，高于CETS组的67.2%、75.0%(χ2=5.833、7.066，P=0.016、0.008)；FETSRAS组内瘘首次使用时间为(36.6±10.5)天，短于CETS组的(43.3±13.1)天(t=2.800，P=0.006)；重复测量数据的方差分析显示：FETSRAS组内瘘手术后12周观察期内，桡动脉内径、头静脉内径及自然血流量均大于CETS组 (F=5.356、7.356、9.154，P=0.022、0.008、0.003)。 结论 与应用CETS技术相比，应用FETSRAS技术建立前臂远端RC-AVF能够促进内瘘成熟并提高内瘘成熟率。
Objective To observe the effect of functional end-to-side anastomosis with radial artery superficial displacement (FETSRAS) on the maturation of radiocephalic arteriovenous fistula (RC-AVF) in the distal forearm. Method Patients undergoing the first RC-AVF creation in distal forearm at the Department of Blood Purification, the People’s Hospital of Rizhao from March 2020 to June 2022 were selected as the study subjects. They were divided into the conventional end-to-side anastomosis (CETS) group and FETSRAS group, according to the method of RC-AVF creation. During the 12 weeks of postoperative follow-up, clinical vascular examination and fistula’s pump controlled blood flow were used to evaluate the clinical fistula maturation status, and color Doppler angiography was used to evaluate the image fistula maturation status. Result A total of 121 patients subjected to distal forearm RC-AVF surgery were enrolled in this study, including 64 cases in CETS group and 57 cases in FETSRAS group. After the creation of fistula for 6 and 12 weeks, the clinical fistula maturation rates were 80.7% and 89.5% respectively in FETSRAS group, higher than those of 64.1% and 73.4% respectively in CETS group (χ2=4.132 and 5.036 respectively, P=0.042 and 0.025 respectively); the image fistula maturation rates were 86.0% and 93.0% respectively in FETSRAS group, higher those of 67.2% and 75.0% respectively in CETS group (χ2=5.833 and 7.066 respectively, P=0.016 and 0.008 respectively). The fistula was used for the first time after 36.6±10.5 days in FETSRAS group, shorter than that after 43.3±13.1 days in CETS group (t=2.800, P=0.006). Variance analysis of repeated measurement data showed that radial artery diameter, cephalic vein diameter and natural blood flow in fistula were higher in FETSRAS group than in CETS group in the postoperative observation period of 12 weeks (F=5.356, 7.356 and 9.154 respectively; P=0.022, 0.008 and 0.003 respectively). Conclusion Functional end-to-side anastomosis with radial artery superficial displacement to create the RC-AVF in the distal forearm obtains a shorter fistula maturation period and a higher fistula maturation rate as compared with those using conventional end-to-side anastomosis.
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