中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (08): 433-435.doi: 10.3969/j.issn.1671-4091.2016.08.014

• 血管通路 • 上一篇    下一篇

头静脉侧支转位术治疗动静脉内瘘术后肿胀手综合征

周乐天1,刘虹1,刘伏友1,吴鹏2,李峥1,李军1   

  1. 1. 中南大学湘雅二医院肾内科
    2. 赣州市中医院肾内科
  • 收稿日期:2016-03-31 修回日期:2016-06-04 出版日期:2016-08-12 发布日期:2016-07-12
  • 通讯作者: 李军 xydoctorlijun@163.com E-mail:xydoctorlijun@163.com
  • 基金资助:

    国家自然科学基金(81300567)；中华医学会临床医学科研专项资金项目(15020130601)

Surgical transposition of collateral branch of cephalic vein to treat the swelling hand syndrome caused by arteriovenous fistula

  • Received:2016-03-31 Revised:2016-06-04 Online:2016-08-12 Published:2016-07-12

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摘要： 目的  评价头静脉侧支转位术重建自体动静脉内瘘治疗内瘘近心端堵闭塞造成的肿胀手综合的疗效。方法自2014 年1 月～2015 年6 月，收集11 例自体动静脉内瘘近心端闭塞造成肿胀手综合征的患者。全部进行了头静脉侧支转位术重建内瘘手术治疗。收集患者的临床资料、手术方式和术后3 月内回访的内瘘使用情况。结果所有患者术后手部肿胀和皮肤溃烂好转。11 例转位术所重建的内瘘有10 例(90.9%)用于维持性血液透析，内瘘使用情况良好。结论内瘘口附近有通往远心端的已经动脉化的头静脉侧支的患者，可行头静脉侧支转位术重建内瘘，既消除肿胀症状，又保留原内瘘，节省静脉，方便透析。

关键词: 自体动静脉内瘘, 肿胀手综合征, 头静脉侧支转位术

Abstract: Objective To evaluate the effect of surgical transposition of collateral branch of cephalic vein to reconstruct arteriovenous fistula for the treatment of swelling hand syndrome caused by proximal blockage of the fistula. Methods In the duration from Jan. 2014 to Jun. 2015, we have collected 11 cases of swelling hand syndrome caused by proximal blockage of autologous arteriovenous fistula in maintenance hemodialysis (MHD) patients. All cases underwent the transposition surgery. Results After the surgery, hand swelling disappeared rapidly with gradually improvement of ulcer symptoms. Reconstructed fistulas were used for MHD in 10 of the 11 cases within 4 weeks after the surgery, and one reconstructed fistula could not be used because of the clog in fistula. After 3 months, another reconstructed fistula was clogged and a new fistula was built in the elbow. Conclusion Proximal blockage of autologous arteriovenous fistula caused the swelling hand syndrome, and surgical transposition of collateral branch of cephalic vein effectively eliminated the swelling hand and reconstructed a new fistula at the same time.

Key words: Arteriovenous fistula, Swelling hand syndrome, Transposition surgery