中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (06): 338-340.doi: 10.3969/j.issn.1671-4091.2016.06.006

• 血管通路 • 上一篇    下一篇

自体动静脉内瘘静脉内膜增生物剥离术前后病理表现

卢方平1,翁艳2   

  1. 清华大学第一附属医院1 肾内科 2 病理科
  • 收稿日期:2016-01-18 修回日期:2016-03-11 出版日期:2016-06-12 发布日期:2016-06-19
  • 通讯作者: 卢方平 bjlufp@163.com E-mail:bjlufp@163.com

Pathological changes in the cephalic vein before and after stripping of venous neointimal hyperplasia in hemodialysis patients with stenosis of arteriovenous fistula

  • Received:2016-01-18 Revised:2016-03-11 Online:2016-06-12 Published:2016-06-19

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摘要： 目的自体动静脉内瘘静脉内膜增生物剥离术能解除狭窄，恢复内瘘功能。但静脉内膜增生物剥离手术后静脉内膜的病理变化不清，本研究探讨此手术前后静脉内膜的病理变化，为该手术的成功提供病理学依据。方法所有静脉标本均取自清华大学第一附属医院近吻合口狭窄的自体动静脉内瘘修复手术患者，采用静脉内膜增生物剥离技术修复动静脉内瘘，增生物剥离前留取约2mm长度的静脉，剥离下来的静脉内膜增生物及剥离后留取约2mm长度的静脉送病理检查与免疫组织化学检查。结果肉眼所见：失功的内瘘静脉较苍白，变硬；切断静脉的静脉壁不规则增厚，增生物与原管壁可见分界线，管腔狭窄，可见血栓；增生物剥离后，血管腔恢复，内壁光滑。剥离前静脉病理表现：静脉内膜纤维性增厚，致管腔重度狭窄，几近闭塞，部分管壁可见粘液样变性。剥离的静脉内膜增生物表现：增生物主要为增生的纤维、肌纤维母细胞及小血管，部分可见血栓形成并机化。剥离后静脉病理表现：静脉管腔完整、管壁光滑，内膜无明显增生组织；血管内皮细胞标记CD34 免疫组织化学染色显示剥离后的静脉内膜仍可见血管内皮细胞存在。结论自体动静脉内瘘近吻合口狭窄的病理基础是静脉内膜增生，静脉内膜增生物剥离后血管内表面仍然有内皮细胞存在。

关键词: 动静脉内瘘, 静脉内膜增生, 病理

Abstract: Objectives Dysfunction of vascular access in hemodialysis is a major cause of morbidity and mortality in hemodialysis patients. The most common cause of vascular access dysfunction is venous stenosis resulting from venous neointimal hyperplasia (VNH) within the peri-anastomotic region of AV fistula. Failed fistula can be restored by VNH stripping. This study investigated the pathological changes of cephalic vein before and after VNH stripping. Methods Vein samples were collected before and after VNH stripping near the site of AV anastomosis. Histological and immunohistochemical studies were performed on these vein samples. Results The majority of the cells in neointima were myofibroblasts (SMA positive). The vascular endothelial cell marker CD34 still existed after VNH stripping. Conclusion Vascular endothelial cell marker CD34 still existed after VNH stripping.

Key words: Arteriovenous fistula, venous neointimal hyperplasia, pathological change