目的 探索小内径头静脉在自体动静脉内瘘(arteriovenous fistula，AVF)成型术中的应用。 方法 对2022年1月1日─2023年12月31日在重庆松山医院肾内科行AVF成型术的患者进行回顾性研究，将患者分为手术前检查手术部位桡动脉内径≥1.5 mm、束臂2分钟头静脉内径1.5～2 mm患者分为小内径组，手术部位桡动脉内径≥1.5 mm、手术部位束臂2分钟头静脉内径≥2mm为常规内径组，手术均由同一位手术医师主刀，比较手术后8周肱动脉流量达标情况，透析时最大泵控血流量达标情况，以及尿素清除率(urea reduction ratio，URR)达标情况。 结果 通过比较小内径头静脉组与常规头静脉内径组AVF的成熟和使用情况，发现2组患者AVF在8周后肱动脉流量达标率(χ2=2.009，P=0.156)、透析最大泵控血流量达标率(χ2=2.509，P=0.113)、尿素清除率达标率(χ2=2.979，P=0.084)差异没有统计学意义。 结论 小内径组与常规内径组AVF在成熟与使用上无统计学差异。对于手术前头静脉内径小于2.0 mm,但大于等于1.5 mm的患者，建立AVF的成功率仍较高，可尝试开展。
Objective To explore the application of small inner diameter cephalic vein in construction of autogenous arteriovenous fistula (AVF). Methods A retrospective study was conducted on patients undergoing AVF construction at the Department of Nephrology, Chongqing Songshan Hospital from January 1, 2022 to December 31, 2023. According to the inner diameter of the cephalic vein at the preoperative surgical site, they were divided into a small inner diameter group and a conventional inner diameter group. The operation was performed by one surgeon. Brachial artery flow rate at 8 weeks after operation, maximum pump-controlled blood flow during dialysis, and urea clearance rate were compared between the two groups. Statistical analysis was performed using SPSS 22.0 software, and P＜0.05 was considered to be statistically significant. Results By comparing maturity and use of AVF between the small inner diameter group and the conventional inner diameter group, we found that there were no significant differences in brachial artery flow rate (χ2=2.009, P=0.156), dialysis maximum pump-controlled blood flow rate (χ2=2.509, P=0.113), and urea clearance rate (χ2=2.979, P=0.084) after 8 weeks between the two groups. Conclusion There were no statistical differences in maturity and use of AVF between the small inner diameter group and the conventional inner diameter group. For patients with preoperative cephalic vein diameter less than 2.0 mm, but greater than or equal to 1.5 mm, the success rate of AVF construction is still high, warranting to be tried surgically.
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