【摘要】 目的比较血液透析患者下肢与上肢人工血管动静脉内瘘的术后通畅率、透析充分性及并发症的情况,为临床上建立下肢人工血管动静脉内瘘提供参考。方法回顾性分析2015年4月至2020年4月在山东第一医科大学附属济南市中心医院肾脏病/血液净化科行下肢和上肢人工血管动静脉内瘘手术的47例患者的资料。结果成功纳入患者47例（下肢17例/上肢30例）,两组患者一般临床资料差异无统计学意义（P>0.05）。下肢术后3个月、6个月、9个月、12个月的初级通畅率分别是94.12%、76.47%、76.47%、70.59%,辅助初级通畅率分别是94.12%、88.24%、88.24%、82.35%,次级通畅率均为100.00%;上肢术后3个月、6个月、9个月、12个月的初级通畅率分别是100.00%、96.67%、83.33%、73.33%,辅助初级通畅率分别是100.00%、100.00%、90.00%、80.00%,次级通畅率分别是100.00%、100.00%、96.67%、96.67%（P₁=0.231/P₂=0.837/P₃=0.833）。二者在透析充分性方面[尿素下降率（URR）和尿素清除指数（Kt/V）]差异无统计学意义（P>0.05）。在术后并发症中,下肢狭窄的发生率比上肢高（83.87%/60.71%）（P<0.05）。结论下肢作为人工血管动静脉内瘘的选建部位,其人工血管动静脉内瘘临床应用效果与上肢比较基本相当。更多还原

【Abstract】 Objective To compare the postoperative patency rate, dialytic adequacy and complications of lower/upper extremity arteriovenous grafts（AVGs）in hemodialysis patients to provide reference for establishing AVGs in lower extremities.Methods During April 2015 and April 2020,a retrospective review of extremity AVGs was performed for 47 hemodialysis（HD）patients.Clinical data, postoperative patency rate, dialytic adequacy and complications were analyzed.Results A total of 47 extremity AVGs were selected.The locations were lower（n=17）and upper（n=30）extremities.No significant inter-group difference existed in general data（P>0.05）.At Month 3/6/9/12,primary patency rates of lower extremity AVGs were 94.12%,76.47%,76.47% and 70.59% and assisted primary patency rates 94.12%,88.24%,88.24% and 82.35% respectively.And all secondary patency rates were 100.00%.The primary patency rates of upper extremity AVGs were 100.00%,96.67%,83.33% and 73.33%,assisted primary patency rates 100.00%,100.00%,90.00% and 80.00% and secondary patency rates 100.00%,100.00%,96.67% and 96.67% respectively（P₁=0.231,P₂=0.837,P₃=0.833）.Dialytic adequacy was not significantly different between two groups（P>0.05）.The incidence of stenosis in lower extremity AVGs was higher than that in upper extremity AVGs（83.87% versus 60.71%,P<0.05）.Conclusion As an alternative site of AVG,the clinical efficacy of lower extremity AVG is similar to that of upper extremity.更多还原