血液透析患者前臂动静脉内瘘的临床应用研究

目的:探讨前臂自体动静脉内瘘在血液透析中的临床应用.方法:对采用前臂腕部自体动静脉内瘘术建立血管通路的112例慢性肾衰竭血液透析患者,进行回顾性分析探讨,建立前臂内瘘的血管条件、手术方式、近远期通畅率、并发症及临床处理原则等.结果:112例患者中,111例手术成功建立血管内瘘,手术一次成功率99.1%(111/112).4周内内瘘栓堵者5例,内瘘初级通畅率94.6%(106/112).其中1例通过药物溶栓获得再通,4例通过原切口行内瘘重建获得再通,累计次级通畅率为99.1%(111/112).动静脉吻合口狭窄致血栓形成是内瘘闭塞最常见因素,感染居其次.内瘘使用后0.5年和1年通畅率分别为97.3%(109/112)和95.5%(107/112).结论:前臂腕部自体动静脉内瘘术制作简便,远期通畅率高,且最大限度地保留了上肢的血管储备,是血液透析血管通路的首选.良好的血管条件和熟练的血管吻合技术是保证内瘘成功和长期通畅的关键因素.

Clinical Study on the Application of Forearm Arterioveneous Fistula in Hemodialysis

Objective:To investigate the clinical application of forearm arteriovenous fistula in hemodialysis.Methods:Forearm arteriovenous fistula(FAVF) was set up as vascular access in 112 hemodialysis chronic renal failure patients undergoing hemodialysis. By means of clinical observation and surveillance, the vascular conditions, surgical methods, fistula patency as well as dysfunction of fistula and reconstruction of fistula were analyzed retrospectively.Results:FAVF was successfully accomplished in 111 out of 112 cases, with first surgical successful rate of 99.1%(111112).The embolism of fistula was found in 5 cases within 4 weeks following the first surgery, and the primary patency rate of FAVF was 94.6% (106112). Re-opening of FAVF was achieved in 1 case by local urokinase thrombolysis and in the other 4 cases by reconstruction of the fistula. The secondary patency rate reached 99.1%(111112). Apart from infection of vascular anastomosis, thrombosis resulted from stenosis of anastomosis was the most common cause of fistula dysfunction in the early stage. The half-year and one-year patency rate of FAVF for hemodialysis was 97.3% (109112) and 95.5% (107112), respectively.Conclusion:FAVF is the first choice for vascular access in hemodialysis for its easier performance and higher patency. Meanwhile, the vessels of the arm are maximally saved for possible future use. The good conditions of the vascular and experienced vascular surgery skills are crucial factors in the successful construction and long-term opening of FAVF.