1256例动静脉内瘘术用于血液透析的临床研究

自１９８５年１月至１９９６年３月为１２５６例慢性透析患者建立动静脉内瘘术并成功地进行了血液透析。自体血管内瘘１１０１例（鼻烟窝动静脉内瘘５２６例，前臂动静脉内瘘５１２例，上臂动静脉内瘘３６例，下肢动静脉内瘘２７例），大隐静脉搭桥１５例，聚四氟乙烯人造血管（ＰＴＦＥ）搭桥动静脉内瘘１８例，人尸动脉搭桥动静脉内瘘１２２例。手术成功率为１００％，１年的通畅率９５．３％，３年的通畅率８２．５％，５年通畅率７１．２％，１０年通畅率４８．６％。就制作动静脉内瘘以及时国内外开展各种制作内瘘方法的临床评价和经验进行了讨论。     

1256例动脉静脉内瘘术用于血液透析的临床研究

自１９８５年１月至１９９６年３月 １２５６例慢怀透析患者建立动脉内瘘术产成功地进行血液透析，自体血管内娄１１０１例（鼻烟窝动静脉内瘘５２６例，前臂动脉内瘘５１２例，上臂动脉静脉内瘘３６上肢动脉内瘘１２２例。手术成功率为１００％，１年的通畅率９５．５％，３的的能摔８２．５％，５年通畅率７１．２％，１０年通畅率４８．６％。就制作动静脉内瘘以及对国内外开展各人瘘方法的临床评价和经验进行了讨论。     

永久性颈内静脉双腔留置透析导管在高龄血透患者中的应用

我院自１９９５年３月以来，对１１例外周血管衰竭、不能建立常规透析内瘘或血管移植内瘘的高龄透析患者，施行永久性颈内静脉双腔透析导管留置进行维持性血透（ＣＨＤ）治疗。ＣＨＤ患者１１例，男５例，女６例，年龄４８～７２岁，平均５８岁，已维持血透治疗２～１３年...     

同种异体血管移植制作动静脉内瘘时吻合口径不同对血液透析病人的临床研究

目的研究动静脉内瘘的不同口径对血液透析的影响与临床意义。方法用7-0无损伤丝线修补裂口和0号线结扎动脉小分支,然后将尸体血管放入肝素盐水中备用。将桡动脉与头静脉或贵要静脉吻合,肱动脉与肘正中静脉做U形吻合,异体血管移植时与动脉行端侧吻合。结果A组病人中,桡动脉与头静脉搭桥5例,与贵要静脉搭桥27例,肱动脉与肘正中静脉搭桥2例,其中行U形搭桥术5例。1年通畅A组94.2%,B组97.8%。结论采用异体血管移植制作动静脉内瘘,穿刺方便,止血容易,是作为生物支架理想材料,并发症少等优点。     

辐照同种异体血管移植的实验研究

目的探讨在不用免疫抑制的条件下，开展同种异体血管移植的可行性。方法（1）在无菌条件及无刨伤原则下切取Wistar大鼠股动脉，-10℃～-20℃保存或真空包装常温保存，16kGy ^60Coγ射线照射。（2）分辐照同种异体血管移植组、新鲜同种异体血管移植组和新鲜自体血管移植组进行血管移植。于移植后1周、2周、1个月、2个月、3个月5个时间点观察移植血管的通畅率，并取材作组织学检测。结果：（1）辐照处理的同种异体动脉无任何组织学结构改变，肉眼观察外形无明显变化。（2）辐照同种异体血管移植组、新鲜同种异体血管移植组和新鲜自体血管移植组移植血管的通畅率分别为90％（27／30）、30％（9／30）和93．3％（28／30）。辐照同种异体血管移植组和新鲜自体血管移植组移植后2周移植血管内膜出现内皮细胞，移植后3个月移植血管内膜内皮细胞覆盖完整。新鲜同种异体血管移植组移植早期有淋巴细胞及炎性细胞浸润，有明显血管结构破坏出现，移植血管内膜未见内皮细胞覆盖。结论辐照同种异体血管完全符合理想的血管移植物所具备的条件；在不使用任何免疫抑制的条件下，应用辐照同种异体血管进行同种异体血管移植是可行的。     

动静脉内瘘的术式选择与血管保护(84例分析)

目的:探讨血液透析动静脉内瘘术的术式选择与血管保护的方法。方法:回顾性分析2001年12月至2005年10月对84例患者分别选择鼻烟窝内瘘术(18例),腕部、前臂头静脉及桡动脉内瘘术(66例)建立动静脉内瘘的临床资料。结果:手术均一期成功,术后内瘘通畅良好。动静脉内瘘使用1～12个月,使用仍良好。7例术前因静脉、动脉穿刺损伤造成了手术困难、血管资源的浪费。结论:鼻烟窝内瘘为首选术式,对于需透析的患者实施整体规划治疗,保护血管有利于血管通路及时、顺利地建立和合理地长期使用。     

颈内静脉双腔留置导管的应用

自１９９６年５月以来,对７例外周血管衰竭、不能建立常规血液透析（血透）内瘘的高龄患者施行永久性颈内静脉双腔透析导管留置进行维持性血液透析（ＨＤ）治疗。　　血透患者７例,男４例,女３例,年龄４２～７８岁,平均５６岁。其中３例已维持血透治疗２～３年,因内瘘闭塞改行置管透析。其余４例因高龄无法行内瘘吻合术而直接插管透析。　　采用ＱｕｉｎｔｏｎＰｅｍｃａＴＨ永久性双腔透析导管,在局麻下行右侧颈部下三角穿刺结合皮下隧道法置管。　　７例患者均１次穿刺成功,无血肿形成。其中最长置管时间为１９个月。共进行血透治…     

人造血管在维持血液透析的应用

目的探讨聚四氟乙烯（PTFE）材质人造血管植入连接动静脉作动静脉内瘘的血管通路效果。方法本文通过506例次人造血管用作透析通路的资料进行回顾分析,并阐明护理操作要点。结果本组案例中人造血管动静脉内瘘使用时间为最长18个月,穿刺264次,最短11个月,穿刺92次。结论为了维持血液透析治疗可建立人造血管搭桥内瘘,加强护理,可以延长人造血管内瘘的使用寿命,提高透析患者的生活质量。     

前臂贵要静脉转位建立动静脉内瘘在透析患者中的应用探讨

目的探讨非常规自体动静脉内瘘建立困难下经前臂贵要静脉转位术内瘘的建立意义。方法对本院2014年2月~2016年8月常规内瘘建立困难患者14例采用前臂贵要静脉转位建立非常规自体动静脉内瘘,与行高位瘘对比,可明显增加可利用血管长度,总结接受这一手术患者节约静脉资源情况的临床资料。结果 14例接受该手术方式的患者手术均一次性成功,术后通畅良好,术后6~8周穿刺使用率为100%,透析血流量在180~250 m L/min。观察内瘘应用中均未发生窃血综合征、肿胀手综合征及肢体缺血等严重并发症,对患者的心功能未造成不良影响。结论大多数的常规内瘘建立困难患者利用前臂贵要静脉进行转位建立自体动静内瘘在技术上是可行的,有效利用了前臂的血管资源,是对上臂静脉宝贵资源的开发与利用,不失为良好的优先于高位内瘘和血管移植内瘘选择。     

1例人造血管堵塞后穿刺吻合口行维持性血液

目的 :为血管条件差、多次内瘘手术失败和在植入人造血管使用 4个月后堵塞的透析患者解决血管通路问题。方法 :穿刺原人造血管与肱动脉端侧吻合口和外周静脉建立血管通路透析间期加强对血管进行热敷。结果 :动脉穿刺成功率 10 0 % ,血流量 >190 m l/m in,透析效果好。患者心血管功能稳定 ,对血液透析耐受性明显高于动静脉内瘘通畅时。未见吻合口狭窄和假性动脉瘤发生。结论 :穿刺吻合口亦能有效地解决血管通路问题并能进行维持性血透。     

围手术期输注红细胞对不停跳下冠脉旁路移植术后近期桥血管通畅率的影响

目的 探讨不停跳下冠状动脉旁路移植术(OPCABG)围术期输入红细胞对于术后近期桥血管通畅率的影响.方法 选择2013 年6月至2015 年6月在安徽医科大学第一附属医院行OPCABG的106例(共127例,失访21例)患者为研究对象,依据患者围术期红细胞的使用与否分为两组:组Ⅰ(输注红细胞组,71例);组Ⅱ(未输注红细胞组,35例).术后1年左右行冠脉CT检查,对比观察两组患者各桥血管通畅情况.结果 组Ⅱ桥血管通畅率(96.97%)高于组Ⅰ(90.40%),差异有统计学意义(P<0.05),组Ⅱ大隐静脉桥血管通畅率(96.92%)高于组Ⅰ(88.15%),差异有统计学意义(P<0.05),而两组间乳内动脉桥血管通畅率比较差异无统计学意义(P>0.05).结论 OPCABG围手术期输血会加大近期大隐静脉桥血管再狭窄的发生率.     

Patency rate and complications of polytetrafluoroethylene grafts compared with polyurethane grafts for hemodialysis access

Abstract

Background. The survival of hemodialysis patients requiring dialysis depends on the long-term functioning and patency of the vascular access. Prosthetic vascular grafts are inevitably used for patients whose vessels are unsuitable for an autogenous arteriovenous (AV) fistula. The purpose of this study was to compare the patency rate and associated complications using different types of grafts.

Methods. This prospective study was conducted on patients who did not have an appropriate vein for arteriovenous fistula from January 2004 through July 2006. They were divided into two groups, sex, age, and basic data matched. Polytetrafluoroethylene (PTFE) and polyurethane (PVAG) were the two types of grafts used in this study. The functionality of the graft was assessed immediately 1 day and 2 weeks after operation. The clinical follow-up was performed each 3 months until 24 months.

Results. One-year patency rate was reported to be 64% and 52% in the PTFE and PVAG groups, respectively. There was no significant difference in 1-year (64% versus 52%) and 2-year (49% versus 41%) patency rate of the PTFE and PVAG grafts used as vascular access. There was also no difference between the numbers of complications reported in the two groups.

Conclusion. It could be concluded that either PTFE or PVAG grafts can be used with the same expected outcomes.     

Patency rate and complications of polytetrafluoroethylene grafts compared with polyurethane grafts for hemodialysis access

Background

The survival of hemodialysis patients requiring dialysis depends on the long-term functioning and patency of the vascular access. Prosthetic vascular grafts are inevitably used for patients whose vessels are unsuitable for an autogenous arteriovenous (AV) fistula. The purpose of this study was to compare the patency rate and associated complications using different types of grafts.

Methods

This prospective study was conducted on patients who did not have an appropriate vein for arteriovenous fistula from January 2004 through July 2006. They were divided into two groups, sex, age, and basic data matched. Polytetrafluoroethylene (PTFE) and polyurethane (PVAG) were the two types of grafts used in this study. The functionality of the graft was assessed immediately 1 day and 2 weeks after operation. The clinical follow-up was performed each 3 months until 24 months.

Results

One-year patency rate was reported to be 64% and 52% in the PTFE and PVAG groups, respectively. There was no significant difference in 1-year (64% versus 52%) and 2-year (49% versus 41%) patency rate of the PTFE and PVAG grafts used as vascular access. There was also no difference between the numbers of complications reported in the two groups.

Conclusion

It could be concluded that either PTFE or PVAG grafts can be used with the same expected outcomes.     

An aggressive policy of bilateral saphenous vein harvest for infragenicular revascularisation in the era of multidrug resistant bacteria

Background: The success of infragenicular revascularisation for lower limb ischaemia is limited by the high proportion of patients without ipsilateral long saphenous vein (LSV) of adequate length or quality. The aim of this study was to report the results of an autogenous vein only policy for infragenicular revascularisation utilising contralateral LSV when ipsilateral LSV is inadequate. The treatment and outcome of infection of autogenous grafts with methicillin resistant Staphylococcus aureus (MRSA) is also reported. Patients and methods: The vascular audit database and patient case notes were reviewed retrospectively for patients with arterial occlusive disease requiring infragenicular reconstruction. There were 68 critically ischaemic legs in 65 patients of whom 48 were male: median age (range) 74 years (41–94), over a three year period. Results: Thirty six patients (53%) underwent revascularisation (eight infragenicular femoropopliteal bypass, 28 femorodistal), 24 (35%) underwent primary amputation and a further eight (12%) were found to have unsuitable distal vessels for revascularisation after tibial vessel exploration and intraoperative angiography. Thirty three grafts (92%) utilised LSV and three (8%) were polytetrafluoroethylene grafts. Thirteen patients (39%) lacked adequate ipsilateral LSV of whom 12 had the contralateral leg explored providing suitable LSV in 10/12 (83%). Contralateral LSV was used as a single length conduit in two cases and as a venovenous composite graft in eight cases. Primary, primary assisted, and secondary patency rates at two years were 38%, 77%, and 81% respectively. Actuarial limb survival and patient survival rates at two years were 86% and 61% respectively. Eleven patients developed ipsilateral wound complications (30%) including seven (21%) who developed MRSA infection of the ipsilateral leg wound. MRSA wound infection was treated successfully in all cases by antibiotic therapy (intravenous vancomycin). No patient subsequently required saphenous vein harvesting for a secondary reconstruction or coronary artery bypass graft. Conclusion: Excellent long term results can be achieved using autogenous vein for infragenicular revascularisation and the contralateral LSV is an excellent alternative in the absence of suitable ipsilateral LSV. Autogenous vein may confer some protection against severe complications observed with MRSA infection seen in vascular patients and therefore its use is recommended.     

微创与常规静脉桥在冠状动脉旁路移植术中桥血管通畅率的对比观察

目的对比观察内窥镜及常规全程切开采集大隐静脉后静脉桥血管近期的通畅率。方法将2006-06～2010-12收治的80例搭桥患者随机分为内窥镜游离(EVH)组和常规切开采集(OVH)组,术后6个月复查64排冠脉CT,对比两组的静脉桥血管通畅率。结果 EVH和OVH组术后6个月静脉桥血管通畅率分别为94.7%和95.2%,两组比较无统计学差异(P>0.05)。结论内窥镜采集的大隐静脉近期内有良好的桥血管通畅率。     

肱动脉-头臂静脉内瘘——慢性肾功能衰竭成功的次选血管通路

目的　对肱动脉 头臂静脉内瘘及前臂袢型PTFE人造血管的生存率及并发症进行分析比较。方法　对 1997年 10月～ 2 0 0 0年 10月间 34例共 35次肱动脉 头臂静脉内瘘手术及 2 9例共 36次PTFE人造血管术进行回顾性分析。所有患者均为以前桡动脉 头臂静脉内瘘失败或丧失功能者。结果　肱动脉 头臂静脉内瘘及PTFE人造血管 1年、2年、3年的生存率分别为 96 .43%和 5 4.2 3%、96 .43%和 48.2 2 %、48.2 2 %和 39.19%(P <0 .0 1)。PTFE人造血管术后并发症次数及最终血管通路丧失功能的数目均明显多于肱动脉 头臂静脉内瘘术 (P <0 .0 1)。PTFE术后并发症以血栓形成最常见 ,其他并发症包括感染、假性动脉瘤、人造血管外露和血清瘤等 ,均需外科手术干预。结论　上臂肱动脉 头臂静脉使用寿命长 ,并发症少 ,作为桡动脉 头臂静脉内瘘失败后的次选血管通路较PTFE人造血管更为理想     

血管重建术治疗糖尿病下肢缺血临床分析

目的 探讨糖尿病动脉硬化造成下肢缺血濒临截肢的外科治疗方法和可行的方案。方法2001年1月至2002年9月收治糖尿病合并严重下肢缺血患者20例，术前平均踝／肱指数(ABI)=0．29，对其中17例21条肢体进行血管重建术，其中人工血管旁路术19条肢体，自体大隐静脉旁路术2条肢体。结果手术后均可及足背或胫后动脉搏动，术后平均ABI=0．87，2例术后24h血管通路阻塞，再次行手术取栓及血管重建术。术后随防2～20个月，一期通畅率88％，再次手术后总通畅率为94．1％。结论对糖尿病伴严重下肢缺血造成下肢濒临截肢的患者采用血管重建术为抢救肢体、降低截肢平面的有效方法。     

Elbow fistulas using autogeneous vein: patency rates and results of revision

Background: The provision and maintenance of vascular access remains a major cost to end stage renal failure programmes. There are few reports regarding the surgical revision of the failing native elbow arteriovenous fistula (AVF). Patients and methods: A retrospective case note review was performed on all patients identified from the hospital vascular access database as having undergone construction of an autogeneous vein elbow AVF. Over a seven year period 282 autogeneous vein AVFs were fashioned in 232 patients using the brachial artery as the in-flow conduit. Of these 208 were brachiocephalic fistulas, or a variant thereof, and 74 were fashioned using the transposed autologous basilic vein (136 male: 96 female; median age 60 years, range 14–94 years). Results: Of 282 elbow fistulas 197 were successfully used for dialysis (70%). Cumulative primary patency of elbow fistulas using autogeneous vein in this series was 68%, 54%, and 44% at one, two, and three years respectively. A further 34 revision procedures were performed on 28 fistulas to maintain fistula function, and cumulative secondary patency after surgical revision was 75%, 60%, and 46% at one, two, and three years. Overall 21 out of 34 procedures (62%) successfully restored fistula function and cumulative primary patency of the revised fistulas was 56% at one year. Eighteen AVFs (brachiocephalic, n=12; autologous basilar vein, n=6) required revision for access dysfunction secondary to a short stenoses within 4 cm of the arteriovenous anastomoses. Of these 18 AVFs eight were revised by excision of the stenosed segment and either primary anastomoses of the two cut ends of arterialised vein or reanastomoses of the proximal venous limb proximally on the brachial artery. In another nine fistulas the excised segment was replaced with a short interposition graft (polytetrafluoroethylene, n=7; native basilic vein, n=1; bovine carotid artery, n=1). One fistula with postanastomotic stenoses and a more proximal needle site stenoses was revised using two vein patches. Overall 100% were patent at 24 hours, 13 provided successful dialysis (72%), and cumulative primary patency was 67% and 50% at six months and one year respectively. Conclusions: Successful surgical revision of failing native elbow fistulas can restore patency and improve cumulative secondary patency with potential benefits in terms of patient morbidity and mortality. These results compare favourably to published patency rates after fistula salvage using interventional radiological techniques.     

冠脉旁路移植手术移植血管的选择

在冠脉旁路移植手术移植血管的选择中，内乳动脉因为其移植10年后仍有高达95％的通畅率而成为首选，而且病人的生存率较高，心血管系统并发症的发生率较低。桡动脉因其1年高于95％的通畅率近年渐被广泛使用，胃网膜右动脉在移植3－4年后的通畅率大于90％，腹壁下动脉1年后的通畅率能达到80％。其他可被选择的旁路血管包括人造血管可在特殊情况下有条件地使用。在选择旁路血管时，需要综合考虑病人的年龄、临床状况和手术类型等多方面的情况。     

维持性血液透析患者动静脉内瘘手术方法的选择

目的了解维持性血液透析患者动静脉内瘘手术方法以及内瘘失功常见原因及其处理。方法回顾性统计1992年12月-2007年12月以动静脉内瘘为血管通路血透患者586例,分别选择自体前臂动静脉内瘘、鼻咽窝动静脉内瘘、移植血管内瘘、人工血管移植内瘘等手术方法。结果586例患者完成统计,共计内瘘手术672例次,前臂及鼻咽窝自体动静脉内瘘手术共611例次,（90.9%）,内瘘失功77例,〉2次内瘘手术77例。结论前臂及鼻咽窝自体动静脉内瘘是维持性血液透析患者的主要手术方式,贵要静脉经皮下隧道与桡动脉吻合内瘘术及自身大隐脉移植动静脉内瘘为血液透析患者提供了一条新的血管通路。