建立血液透析用血管通路406例总结

目的：总结血液透析用血管通路手术经验，提高建立理想血管通路的成功率。方法：回顾分析1998年1月-2003年1月对406例血液透析患者建立438个血管通路的手术部位、方式、技巧及常见血管问题的处理。结果：自然动静脉内痿手术总成功率98．15％(425／433)，其中左前臂384例次、右前臂24例次(尺动脉侧手术9例次)，鼻烟窝处25例次。行人工血管内痿成形术4例次，动脉浅置术1例次。最终因血管不良或心脏功能不能耐受改其他方法10例(2．46％)。结论：①绝大多数血液透析者可建立自然动静脉内痿，手术简单易行，并发症少，使用安全舒适。②正确选用手术方式、改进手术技巧及掌握血管常见问题的处理，可提高动静脉内瘘的手术成功率。③腕部内瘘手术失败，肱动脉一头静脉内痿为次选血管通路。不能建立自然动静脉内痿时，人工血管搭桥、动脉浅置术也可用于血管通路。④低血压是内痿血管堵塞的常见原因。

Review of 406 cases with hemodialysis of internal arteriovenous fistulas

Objective:To summarize the experience of hemodialysis of internal arteriovenous fistula for improving the procedure of setting up proper vascular route. Methods:406 hemodialysis cases set up internal internal arteriovenous fistula from Jun.1998 to Jun. 2003 were studied retrospectively. Experience of operation location, methods, techniques and management of common disorders of vessels of 438 procedures were summarized. Results:Successful rate of internal arteriovenous fistula was 98.15% (425/433) and the total successful rate of operation was 99.3% (435/438), including 384 cases in left forearm, 24 cases in right forearm, 25 cases in radial place, 9 in ulna side, 4 used artificial vascular fistula and 1 raised artery under skin. 10 changed to other procedures because vascular or heart function was in poor condition.Conclusion:1.Most patients are suitable to set up natural internal arteriovenous fistula because it is easy to do and less complication. 2. To select right operation method, to improve the technique of operation and to manage the common disorders of vessels will raise the rate of success. 3, If operation is failure in carpal position, it should be performed in elbow field or changed to other means. 4, Hypotension is common reason of blocking the vascular fistula.