中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (03): 182-185.doi: 10.3969/j.issn.1671-4091.2018.03.008

• 血管通路 • 上一篇    下一篇

瘤体修复术治疗血管通路静脉瘤样病变初步疗效分析

葛玮婧1,施娅雪1,陆峰1,陈佳佺2,胡婧伊1,刘思洁1   

  1. 1. 上海中医药大学附属龙华医院血管外科
    2. 上海交通大学医学院附属仁济医院
  • 收稿日期:2017-08-28 修回日期:2017-10-23 出版日期:2018-03-12 发布日期:2018-03-12
  • 通讯作者: 施娅雪 drshiyaxue@163.com E-mail:drshiyaxue@163.com
  • 基金资助:

    上海市卫计委课题：201540122

Clinical outcome of aneurysmorrhaphy for true venous hemodialysis access aneurysms

  • Received:2017-08-28 Revised:2017-10-23 Online:2018-03-12 Published:2018-03-12

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摘要： 【摘要】目的总结瘤体修复术治疗血液透析血管通路静脉瘤样病变的疗效及经验。方法回顾性分析笔者在2014 年10 月～2017 年5 月收治的34 例血液透析血管通路静脉瘤样病变的临床资料。总结其病因、治疗方法及效果。结果本组男17 例，女17 例，平均年龄(53.33±12.73)岁。平均血管通路建立时间(26.14±32.92)月，病程1 周～13 年。27 例存在狭窄或闭塞病变(占79.4%)，合并血栓7 例，钙化9例。34 例病例，共行40 次瘤体修复手术，6 例行分二期修复。并同期纠正近心端狭窄，3 例瘘管缩窄。术后1 个月穿刺使用，随访时间1 个月～31 个月，平均随访时间(9.08±8.74)个月。失访1 例，其余病例均通畅。4 例瘤体增大。结论血管通路静脉瘤样病变多继发于局部狭窄或闭塞病变，需早期发现。瘤体修复术在切除瘤样病变的同时最大程度地保留了静脉资源，避免中心静脉插管，手术创伤虽大，但通畅率好，并发症低，在临床有一定的实用价值。

关键词: 血透通路, 瘤样扩张, 瘤体修复

Abstract: 【Abstract】Objectives To summarize the effect and management experiences of aneurysmorrhaphy for arteriovenous fistula (AVF) aneurysms in hemodialysis patients. Methods Thirty- four hemodialysis patients with AVF aneurysm treated between October 2014 and May 2017 were retrospectively analyzed. Etiology, management method and outcome were summarized. Results There were 17 males and 17 females with the mean age of (53.33±12.73)years old. The average time of AVF creation was (26.14±32.92)months. Aneurysm was present from one month to 13 years. Stenosis or occlusion lesions existed in 27 cases, thrombosis in 7 cases, and calcification in 9 cases. Thirty-four cases underwent 40 aneurysmorrhaphy operations, and 6 cases underwent two stage repair. The proximal stenosis was corrected. Three cases had constriction of the fistula. The fistulas were reused for blood access after the operation for one month. Patients were followed up for 1~31 months with the average follow-up period of (9.08±8.74)months. AVFs were patent except in one case that was dropped out from our follow-up. Enlargement of aneurysms occurred in 4 cases. Conclusions AVF aneurysm is often secondary to stenosis or occlusion lesions in hemodialysis patients, and should be detected and treated earlier. Although the surgical trauma is bigger, aneurysmorrhaphy largely preserves the venous resources, avoids central venous catheterization, and results in high patency rate and low complications. This surgery has clinical values in practice.

Key words: Vascular access, Aneurysms, Aneurysmorrhaphy