动静脉内瘘合并上肢肿胀成因及对策探讨

目的探讨血液透析自体动静脉内瘘使用后上肢肿胀形成的影响因素。方法回顾性分析自体动静脉内瘘合并上肢肿胀的18例慢性肾衰竭患者的病例资料，总结其形成因素、手术方案并提出针对性的预防措施及手术对策。结果瘘管狭窄占72．2％、通路同侧肢体中心静脉狭窄占11．1％、瘘管血流量过大占16．7％，通过近端动静脉内瘘重建手术上肢肿胀改善者11例、因经济原因选择结扎内瘘者2例。结论充分的术前检查、正确选择手术血管、控制吻合口尺寸、注意静脉分支的处理是预防上肢肿胀的必要措施。采取内瘘重建、血管移植可以挽救绝大多数合并肿胀的内瘘。

The causal and therapeutic strategy of swollen complication of upper-extremity arteriovenous autogenous access

Objective To discuss the factors influencing swollen complication of upper-extremity arteriovenous autogenous access for hemodialysis. Method Retrospective analysis was performed on 18 chronic renal failure patients with swollen limbs after internal arteriovenous fistula. The causes of swollen limbs and operative procedures were investigated. Result In all cases, 72. 20% swollen limbs were caused by fistulous stenosis, 11.1% by central vein stenosis of ipsilateral limbs, and 16. 7 % by redundant input. 11 patients with swollen limbs were improved by reoperation of internal arteriove nous fistula, and 2 were subjected to ligation of internal arteriovenous fistulae. Conclusion To avoid limbs swelling, to carry out sufficient preoperative examination, select operative blood vessels, control the dimension of stoma and to ligate venous branches are the necessary measures. The measures including reoperation of internal fistula and vasotransplantation can save most of the swollen internal fistulae.