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。

The choice of the operation methods on the creating of arterioveneous fistula in maintenance hemodialysis patients

Objective To investigate the creating methods of arterioveneous fistula in hemodialysis patients, and to analyze the common causes of faistula failure and its management. Methods Compare the different patterns of creating the arterioveneous fistula in hemodialysis patients from Dec 1992 to Dec 2007 ,including autogenous forarm fistula,snuffbox fistula,graft fistula,and artifical graft fistual etc. Results There were 586 patients in total who have completed the investigation,in which 672 times of operation were done to format the fistula, there were 611 cases of autogenous forarm and snuffbox fistula,which occupied 90. 9%. Fistula failure was observed in 77 patients. There were 77patients who received more than 2 times of operation. Conclusion Autogenous forarm and snuffbox fistula is the main vascular access in maintainging hemodialysis patients. The new ways of acce.ss creating for hemodialysis patients include anastamosis of basilica vein transposited via the subcutaneous tunnel with brachial artery and autogenous saphenous vein graft fistula.