Abstract：Objective To improve the success rate of arteriovenous fistula operation by studying the clinical effect of three different vascular suturation techniques: continuous suture,continuous-discontinuous suture and discontinuous suture. Methods A total of 98 patients that underwent autogenous arteriovenous fistula operation in Nanjing Central Hospital from September 2015 to May 2017 were selected. In the same operation condition, they were randomly divided into three groups according to different vascular suturation technique: continuous suture group (32 cases), continuous-discontinuous suture group (33 cases) and discontinuous suture group (33 cases). Then, the one-time success rate of operation, the fistula patency rate postoperative 24 hours, 3 months, 6 months, the diameter of anatomosis and the blood flow change of fistula postoperative 1 month, 3 months, 6 months were compared among the three groups, and statistical analysis was made to analyze the data. Results The one-time success rate of operation among the three groups had statistically significant difference (P ＜ 0.05). The one-time success rate of continuous-discontinuous suture group was higher than those of continuous suture group and discontinuous suture group that had statistically significant differences (P ＜ 0.05). The fistula patency rate in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 3 months and 6 months (P ＜ 0.05). The fistula patency rate in the discontinuous suture group was higher than the continuous suture group postoperative 24 hours, 3 months and 6 months (P ＜ 0.05). The fistula patency rate had difference among the three groups (P < 0.05). The diameter of anatomosis in the continuous-discontinuous suture group and discontinuous suture group were longer than the continuous suture group postoperative 1, 3 and 6 months (P ＜ 0.01); the diameter of anatomosis in the discontinuous suture group was longer than the continuous-discontinuous suture group postoperative 1 month and 6 months (P ＜ 0.05); the diameter of anatomosis among the three groups had high statistically significant difference (P < 0.01). The blood flow of fistula in the continuous-discontinuous suture group was higher than the continuous suture group postoperative 1, 3 and 6 months (P ＜ 0.05); the blood flow of fistula in discontinuous suture group was higher than the other two groups postoperative 1 month and 6 months (P ＜ 0.05); the blood flow of fistula among the three groups postoperative 1, 3, 6 months had statistically significant difference (P < 0.01). Conclusion The continuous-discontinuous suture is a good suturation manner that combines the advantages of continuous suture and discontinuous suture, and it is a good technique for vascular anastomosis in internal arteriovenous fistula.
[1] Smith GE，Gohil R，Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access [J]. J Vasc Surg，2012，55（3）：849-855.
[2] 温玉，敬春兰.动静脉内瘘吻合术术式比较及临床分析[J].西部医学，2011，23（1）：98-100.
[3] Anel RL，Yevzlin AS，Ivanovich P. Vascular access and patient outcomes in hemodialysis：questioning recent literature [J]. Artificial Organs，2003，27（3）：237-241.
[4] 何强，李贵森，康志敏，等.影响动静脉内瘘成熟的因素探讨[J].中国血液净化，2009，8（7）：369-371.
[5] 陈忠，武威，吴庆华.两种不同部位透析用动-静脉内瘘成形术的手术效果评估和治疗体会[J].中华医学杂志，2003，83（24）：11-13.
[6] 王世相，管德林.血液透析患者血管通路的合理建立和使用[J].中国血液净化，2003，2（8）：14-15.
[7] 王亚平，曾召君.显微外科技术建造前臂动静脉内瘘33例分析[J].贵州医药，2005，29（8）：731.
[8] Salimi F，Majd NG，Moradi M，et al. Assessment ofeffects of upper extremity exercise with arm tourniquet on maturityof arteriovenous fistula in hemodialysispatients [J]. J Vasc Access，2013，14（3）：239-244.
[9] Smith GE，Gohil Ｒ，Chetter IC. Factors affecting the patencyof arteriovenous fistulas for dialysis access [J]. J Vasc Surg，2012，55（3）：849-855.
[10] Brescia MJ，Cimino JE，Appel K，et al. Chronic hemodialysis using venipuncture and surgically created arteriovenous fistula [J]. N Engl J Med，1966，275（20）：1089-1092.
[11] 王玉柱.血液净化通路[M].北京：人民军医出版社，2009：78-94.
[12] Jindal K，Chan CT，Deziel C. Clinical Practice Guidelines for Hemodialysis：Chapter 4：Vascular Access. Canadian Society of Nephrology [J]. Journal of the American Society of Nephrology，2006，17（3 Suppl 1）：S1-S27.
[13] Woods JD，Port FK. The impact of vascular access for hemodialysis on patient morbidity and mortality [J]. Nephrol Dial Transplant，1997，12（6）：657-667.
[14] 何强，李贵森.影响动静脉内瘘成熟的因素探讨[J].中国血液净化，2009，8（7）：369-371.
[15] 徐元恺，张文云，段青青，等.吻合口动脉端狭窄致自体动静脉内瘘早期失功的初步研究[J].中国血液净化，2016， 15（9），494-497.
[16] 宋会中，郭丽霞，李鹏，等.连续锁边缝合行腕部自体动静脉内瘘成形术[J].临床医药文献电子杂志，2016，3（8），1463-1464.
[17] 刘杰，戈小虎，任昊，等.3种血液透析动静脉内瘘手术方式的体会[J].中国现代医学杂志，2006，16（21）：3317-3319.
[18] 杨垒，蒲涛，裘志诚，等.改良式动静脉内瘘吻合术36例临床分析[J].中国临床新医学，2011，4（4）：364-366.
[19] 邓永高，陈伟明，周强，等.血液透析动静脉内瘘不同手术方式对心功能的影响[J].中华显微外科杂志，2002，25（2）：156-157.
[20] 钟伟强，杨铁城，刘冠贤，等.血液透析动静脉内瘘显微吻合不同口径的影响[J].中华显微外科杂志，1999，22（2）：73-74.
[21] 王红梅.向心穿刺法对血液透析患者动静脉内瘘的并发症影响分析[J].中国医药科学，2016，6（1）：214-216.
2018, Vol. 15 
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