前臂自体动静脉内瘘建立血液透析通路的临床分析

目的探讨终末期肾功能衰竭患者前臂自体动静脉内瘘建立的手术方式、手术经验及应用价值。方法总结我科2007年1月—2013年3月施行自体动静脉内瘘术106例患者的临床资料,其中鼻咽窝内瘘组（82例）,腕部内瘘组（24例）;术后吻合口急性闭塞探查Fogarty取栓5例,吻合口狭窄并血栓形成再次手术取栓加球囊扩张再通4例。分析手术方式的选择、操作要点、成功率及并发症原因。结果 106例自体动静脉内瘘术,成功98例（92.5%）,失败8例（7.5%）,取栓后再次闭塞1例,患肢不同程度水肿42例。无高输出量心力衰竭及窃血综合征发生。3个月后彩色多普勒超声检查内瘘血流量大于300 mL/min。结论鼻咽窝内瘘为建立血液透析通路的首选方式,腕关节内瘘同样可以成功建立透析通路,积极行术后并发症处理,可避免再次内瘘成形。

A clinical analysis of dynamic forearm autogenous hemodialysis pathway of arteriovenous fistula

Objective To investigate the end-stage renal failure patients with forearm operation mode,establish the fistula intravenous operation experience and application value. Methods in our department from 2007 to 2013 implementation of internal arteriovenous fistula in 106 cases of clinical data,wherein thesnuffbox arteriovenous fistula group （82 cases）,wrist fistula group （24 cases）,postoperative anastomotic acute occlusion detection Forgarty thrombectomy in5cases,anastomotic stenosis and thrombosis embolectomy operation again balloon dilatation of recanalization in 4 cases. Reasons for success rate and complications of operation mode,operation points. Results 106 patients with autologous arteriovenous fistula,98（92.5%）cases were successful,failed in 8（7.5%）cases,1 cases of re occlusion thrombectomy,42 cases of limb edema patients. No high output heart failure and stealsyndrome. Color Doppler ultrasound examination of fistula blood flow more than 300ml/min after March. Conclusion snuffbox arteriovenous fistula is the preferred way to access for hemodialysis,the same wrist fistula can successfully recommended hemodialysis access,to treat the postoperative complication,can avoid the fistulae.