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连续缝合技术与间断缝合技术在建立血液透析血管通路中的比较研究:基于机构的经验

A Comparative Study of Continuous Versus Interrupted Suturing Technique in Creating a Vascular Access for Hemodialysis: An Institutional-Based Experience.

作者信息

Roy Siddhant, Bhat Mahakshit, Ahmed Nisar, Sharma Lokesh, Mathur Rajeev, Tomar Vinay

机构信息

Urology, National Institute of Medical Sciences, Jaipur, IND.

出版信息

Cureus. 2023 Jul 17;15(7):e42004. doi: 10.7759/cureus.42004. eCollection 2023 Jul.

Abstract

Background Arteriovenous fistulas (AVFs) are considered the first and best access for patients with end-stage renal disease who need permanent vascular access for hemodialysis over arteriovenous grafts and central venous catheters for reasons that have been well-established. Poor early patency rates pose the biggest challenge in creating vascular access as they cause increased morbidity and economic/psychological concerns among patients. To minimize such effects, it is critical to use a patient-centered approach and carefully choose patients for AVF access creation. This study aimed to compare the primary patency of distal vascular access provided by continuous suturing versus that provided by interrupted suturing. Methodology This prospective study was conducted in the urology department of a superspecialty, tertiary care center from November 2021 to November 2022. Patency was assessed immediately after surgery (on the table), one month later, and six months later by palpating thrill and auscultating bruit. A total of 50 patients between the ages of 18 and 70 years who met the inclusion criteria were randomly assigned to two groups of 25 each. Results The baseline characteristics of both groups were comparable. At six months (p = 0.09), the continuous suturing group was observed to be somewhat better than the interrupted suturing group, with no significant difference in immediate and one-month patency rates. When compared to the continuous suturing group, the primary patency failure rate was significantly higher in the interrupted suturing group. Conclusions Thus, under appropriate circumstances, continuous sutures can be performed with greater ease, resulting in anastomosis that is as patent as that performed with interrupted sutures.

摘要

背景 动静脉内瘘(AVF)被认为是终末期肾病患者进行血液透析所需永久性血管通路的首选且最佳方式,相较于动静脉移植物和中心静脉导管,其优势已得到充分证实。早期通畅率不佳是建立血管通路面临的最大挑战,因为这会增加患者的发病率以及经济和心理负担。为尽量减少此类影响,采用以患者为中心的方法并谨慎选择适合进行AVF通路建立的患者至关重要。本研究旨在比较连续缝合与间断缝合提供的远端血管通路的初始通畅情况。

方法 本前瞻性研究于2021年11月至2022年11月在一家超专科三级护理中心的泌尿外科进行。术后即刻(手术台上)、术后1个月和6个月通过触诊震颤和听诊杂音评估通畅情况。共有50名年龄在18至70岁之间符合纳入标准的患者被随机分为两组,每组25人。

结果 两组的基线特征具有可比性。在6个月时(p = 0.09),观察到连续缝合组略优于间断缝合组,即刻和1个月时的通畅率无显著差异。与连续缝合组相比,间断缝合组的初始通畅失败率显著更高。

结论 因此,在适当情况下,连续缝合操作更简便,可实现与间断缝合同样通畅的吻合效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7836/10428183/889d9834e541/cureus-0015-00000042004-i01.jpg

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