儿童血液透析动静脉内瘘建立的临床方法改进探讨

目的探讨儿童血液透析动静脉内瘘建立的临床方法。方法收集郑州大学第一附属医院2006年1月～2012年1月19例以动静脉内瘘作为永久性血管通路的患儿,其中男12例,女7例,制作内瘘时平均年龄为12.21±3.17岁(7～17),平均体质量为31.16±9.85Kg。有16例是以血液透析作为首选的肾脏替代治疗,3例为腹膜透析转为血液透析。观察患儿的动静脉内瘘的使用时间、成熟时间、内瘘并发症及转归情况。结果 19例患儿共行31次手术(包括初始手术和再次手术),动静脉内瘘平均成熟时间9.84±5.6(4～25)周,内瘘的平均使用时间为18.95±17.32(3～64)个月。其中左前臂手术21例次(67.7%),右前臂手术7例次1(22.6%),上臂手术3例次(9.6%)。初始失败率22.6%(7/31),24例次(77.4%)动静脉内瘘并发症:血栓形成4例次(16.7%),狭窄、假性动脉瘤、高输出量和静脉输出道高压各1例次(4.2%),需要血管重建或缩窄术。结论良好的团队协作及适时的显微技术的应用可以提高儿童动静脉内瘘的成功率及使用时间。

The establishment of arteriovenous fistula in pediatric hemodialysis patients

Objective The aim of the study was to summarize our experience of arteriovenous fistula （AVF） establishment for hemodialysis （HD） in children and adolescents with end-stage renal disease （ESRD） with the emphasis on complication rate and causes of access failure in these children. Methods We retrospectively studied the AVF patency period, maturation time, complication and outcome of the AVF for long-term blood access in 19 children （7 females and 12 males; mean body weight 31.16±9.85 kg） treated in this hospital during the period through Jan. 2006 to Jan. 2012. They were 12.21±3.17 （7-17） years old at the establishment of AVE HD was the primary renal replacement therapy in 16 children, and was the therapy secondary to peritoneal dialysis in 3 children. Results There were 31 operations including primary and secondary operations in the 19 patients. The average maturation time for AVF was 9.84±5.6 （4- 25） weeks, and the average patency period lasted 18.95±17.32 （3-64） months. AVF located in left forearm in 21 （67.7%）, in right forearm in 7 （22.6%）, and in cubital fossa in 3 （9.6%） of the 31 AVF operations. The primary AVF establishment failed in 7 of the 31 operations （22.6%）. Complications causing re-operations or constriction operations occurred in 24 of the 31 operations, including thrombosis in 4, stenosis in 1, anen- rysm formation in 1, high output in l, and venous hypertension in 1 of the 24 operations. Conclusions Better cooperation in a medical team and microsurgery performance are required to obtain an ideal success- ful rate and a long patency period for AVF in children.