扩张小口径静脉建立自体动静脉内瘘

目的：评价用球囊扩张小口径头静脉建立自体动静脉内瘘用于血液透析的有效通畅率。方法：2007年1月—2009年12月,对67例尿毒症患者初次建立自体动静脉内瘘。根据术前彩超测量患者头静脉直径将40例头静脉直径〈2.5mm患者分入研究组,27例头静脉直径〉2.5mm患者分入对照组。研究组患者用Fogarty球囊扩张头静脉,使其直径〉2.5mm后行头静脉-桡动脉内瘘术,对照组按传统方法行内瘘手术。术后观察内瘘通畅率及并发症情况。结果：67例患者随访3-36个月,平均18个月。58例开始应用内瘘进行血透。9例内瘘术失败。其中研究组5例,对照组4例。12个月的初次、累积通畅率研究组分别为64%和72%,对照组分别为60%和76%。结论：用球囊扩张小口径头静脉至其直径〉2.5mm后和桡动脉行端端吻合可得到有效的血液透析通路,其远期通畅率尚需观察。

Studies on Using Small Caliber Cephalic Vein to Construct the Autogenous Radial-Cephalic Hemodialysis Access

Objective：To discuss the patency of the autogenous radial-cephalic hemodialysis access using small caliber cephalic vein.Methods：From January 2007 to September 2009,67 patients with uremia received operation of radial-cephalic hemodialysis access.All patients were the first time to establish autogenous arteriovenous fistula（AVF）.The experimental group（EG） consisted of 40 patients who use the Fogarty catheter.The fistula were placed only for veins ≤2.5 mm in diameter by measuring with the ultrasound.The other 27 patients who have normal cephalic vein（diameter〉2.5 mm） make up control group（CG）.They received the traditional operation.Follow up the patency rates and complication rates of the fistula after procedure.Results： Follow up the information of all the 67 patients completely.The shortest follow-up was 3 months and the longest was 36 months.Mean follow-up was 18 months.Five AVFs were failure in EG and 4 in CG.58 patients had received hemodialysis using radial-cephalic access.Primary and secondary patency rates were 64% and 72% at 12 months for EG and 60% and 76% at 12 months for CG,respectively.Conclusions： The method is convenience to overcome the stenosis of the vessels.Partial patients who have small caliber cephalic vein（diameter〈2.5 mm） can get ideal access.The long term effects need to be observed further more.