中国血液净化

›› 2003, Vol. 2 ›› Issue (10): 543-545.

• 论著 • 上一篇    下一篇

前臂血管转位建立自体动静脉内瘘的临床研究

陆 石 田 军 韩国锋 于秀峙 胡大勇 孙 晶 王会玲 张金元   

  1. 200052 上海,上海市解放军第四五五医院肾脏病科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-10-19 发布日期:2003-10-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-10-19 Published:2003-10-19

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摘要：

目的 研究前臂血管转位术在非常规动静脉自体血管内瘘中的建立及临床效果。方法 采用前臂贵要静脉转位、桡动脉转位、桡动脉与贵要静脉转位会师三种方法建立非常规自体动静脉内瘘。结果 93例手术无1例失败，其穿刺使用率为97.8%，透析血流量达 180～250ml/ in， 1～3 年通畅率桡动脉转位术略高于其他两种转位术，血管转位内瘘的主要并发症是感染 1.1%、血栓形成 4.3%、吻合口狭窄1.1%和瘤样扩张5.4%，1～3年通畅率分别为84.9%、73.1%和62.4%。结论 前臂血管转位内瘘对大多数的病例在技术上是可行的，能够用于前期经多次血管通路操作的患者，在常规内瘘不能建立时优先于肘窝内瘘、上臂内瘘和血管移植内瘘被考虑，是采用自体血管建立动静脉内瘘的第二选择。

关键词: 血管转位, 动静脉内瘘, 血液透析

Abstract:

Objective To establish a non-routine autogenous arteriovenous fistula by the vascular～transposed operation in forearm for hemodialysis and observe its clinical effect. Methods To use the following three methods as transposing basilic vein and radial artery in forearm or anastomosing the two vascular to establish some non-routine autogenous arteriovenous fistula. Results We have done 93 operations, which were all successful, the rate of usage is 97.8%, the fistula's flow capacity was up to 180～250ml/min. During 1～3 years, the patency rate of transposed-Radial artery is higher than the other two methods. The mainly complications in vascular-transposed operation are infection(1.1%), thombsis(4.3%), anastomotic stenosis (1.1%) and varicosity (5.4%). The patency rate during 1～3 years is 84.9%, 73.1%, and 62.4% respectively. Conclusion The transposed forearm-vascular autogenous arteriovenous fistula is technically feasible in most cases, it can be used in the patients who have undergone vascular-access procedures. If the normal fistula cannot be established, the transposed forearm-vascular arteriovenous fistula could be better than elbow-fistula, upper arm-fistula, and PTFE graft-fistula. It is a second selection to establish arteriovenous fistula.

Key words: Arteriovenous fistula, Hemodialysis