中国血液净化

›› 2004, Vol. 3 ›› Issue (7): 364-366.

• 论著 • 上一篇    下一篇

自体动静脉内瘘狭窄的介入和手术治疗

安茂竹 陈希平 孙 静 宋明娟 丁英昌 苑芳昌 牟善宵   

  1. 276800 日照，山东省日照市人民医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-07-12 发布日期:2004-07-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-07-12 Published:2004-07-12

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摘要：

目的 探讨自体动静脉内瘘狭窄的治疗方法。方法 自1998年2月～2004年2月，我们对16 例自体动静脉内瘘狭窄的维持性透析患者进行了介入和手术治疗。对单纯一处狭窄的3例患者采用气囊导管扩张（PTA）治疗。对多处狭窄或一处狭窄但范围较大者采用手术治疗，在狭窄的动脉端和静脉端，分别沿原内瘘血管做纵行切口，行端端、端侧或侧侧吻合，吻合口直径为5.0～8.0mm。前臂血管狭窄严重的患者，建立高位内瘘。结果 16例患者中有3例采用PTA技术治疗，术后即出现血管杂音再现且血流量恢复，但分别在3、5、9个月后再次出现狭窄，血流量不足而行手术治疗。所有手术患者一次取得成功，成功率为100%，术后血流量达200～350ml/min。对患者的心功能未造成不良影响。结论 自体动静脉内瘘狭窄形成后，及时采用介入和手术治疗是尽量利用自身血管，修复失功能内瘘的一种行之有效的方法。

关键词: 动静脉内瘘, 狭窄, 假性动脉瘤, 介入手术治疗

Abstract:

Objective To investigate the treatment of native arteriovenous fistula (AVF) stenosis. Methods Sixteen maintenance hemodialysis patients with native arteriovenous fistula stenosis were treated with intervention and surgery from February 1998 to February 2004. Three patients were treated with percutaneous transluminal angioplasty(PTA) for only one site stenosis. The multiple stenosis patients or stenosis lesions in great area of arteriovenous fistula were treated with surgery. Results The stenosis recurrence were at 3、5 and 9 months, respectively of the three PTA patients and then these patients were treated with surgery. All other patients were also treated with surgery, The surgery success rate were 100%. The blood flow reached 200～350ml/min after operation. There were no side effect on cardiac function. Conclusion It was an effective method of PTA and surgery for maintenance hemodialysis patients with native arteriovenous fistula stenosis.

Key words: Stenosis, Intervention, Surgery 

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