Wang X H, Dong P, Liu Z, Zhang Y Y, Hou G C
Department of Nephrology, Suzhou Science & Technology Town Hospital, Suzhou 215000, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 14;103(10):714-719. doi: 10.3760/cma.j.cn112137-20221122-02465.
To explore the clinical efficacy of a modified no-touch technique (MNTT) in establishing autogenous arteriovenous fistulas (AVF) in hemodialysis patients. A total of 63 patients with AVF which was first established by MNTT in the Department of Nephrology, Suzhou Science and Technology Town Hospital from January 2021 to August 2022 were retrospectively included. The clinical data, ultrasound evaluation data of AVF, AVF maturity rate and AVF patency rate were collected. Subsequently, the AVF rate of patients in the MNTT group was compared with the patency rate of patients in the conventional operation group in the same hospital from January 2019 to December 2020. The Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the difference in postoperative patency rate between the two groups. There were 63 cases in the MNTT group, with 39 males and 24 females, and aged (60±17) years. Meanwhile, there were 40 cases in the conventional operation group, including 23 males and 17 females, and aged (60±13) years. In the MNTT group, the immediate patency rate was 100% (63/63) after surgery, and the AVF maturation rate at 2, 4 and 8 weeks postoperatively were 54.0% (34/63), 85.7% (54/63), and 90.5% (57/63), respectively. The primary patency rate was 90.0% (45/50), 85.0% (34/40), 82.9% (29/35), and 81.0% (17/21) at 3, 6, 9 months, and 1 year after the operation, respectively, and the assisted patency rates were all 100.0%. The one-year primary patency rate in the MNTT group was higher than that in the conventional surgery group (81.0% versus 63.5%, log-rank χ=5.12, =0.023). Ultrasound results showed that in the MNTT group, AVF veins were evenly dilated, the vascular wall gradually thickened, the brachial artery blood flow gradually increased, and spiral laminar flow occurred in the cephalic vein and radial artery. AVF established by MNTT features with fast maturity and a high patency rate, which is worthy of clinical promotion.
探讨改良非接触技术（MNTT）在血液透析患者自体动静脉内瘘（AVF）建立中的临床疗效。回顾性纳入2021年1月至2022年8月在苏州科技城医院肾内科首次采用MNTT建立AVF的63例患者。收集临床资料、AVF的超声评估数据、AVF成熟率和AVF通畅率。随后，将MNTT组患者的AVF通畅率与同一医院2019年1月至2020年12月常规手术组患者的通畅率进行比较。采用Kaplan-Meier法绘制生存曲线，采用对数秩检验比较两组术后通畅率的差异。MNTT组63例，男39例，女24例，年龄（60±17）岁。同时，常规手术组40例，男23例，女17例，年龄（60±13）岁。MNTT组术后即刻通畅率为100%（63/63），术后2、4、8周AVF成熟率分别为54.0%（34/63）、85.7%（54/63）、90.5%（57/63）。术后3、6、9个月及1年的初级通畅率分别为90.0%（45/50）、85.0%（34/40）、82.9%（29/35）、81.0%（17/21），辅助通畅率均为100.0%。MNTT组的1年初级通畅率高于常规手术组（81.0%对63.5%，对数秩χ=5.12，P=0.023）。超声结果显示，MNTT组AVF静脉均匀扩张，血管壁逐渐增厚，肱动脉血流逐渐增加，头静脉和桡动脉出现螺旋状层流。采用MNTT建立的AVF具有成熟快、通畅率高的特点，值得临床推广。
