血液透析患者动静脉内瘘的建立及并发症的处理

目的 通过对449例内瘘患者的总结，探讨更好的血透患者的内瘘制作方法及并发症的处理。方法 总结我院从1996年开始由肾内科实行的内瘘手术449例，分别采用直接动静脉缝合制作内瘘和人尸体血管搭桥建立动静脉内瘘。直接缝合多于前臂桡侧腕横纹上3－5cm或鼻烟窗处将头静脉与桡动脉作端侧或端端吻合；前壁尸侧腕横纹上贵要静脉与尺动脉及下肢大隐静脉与足背动脉端侧吻合。比较各种类型的内瘘的成功率和并发症发生率。结果 该法制作的内瘘的成功率少，并发症少。4年的内瘘通畅率达92％。结论 采用动静脉直接吻合制作内瘘仍然是建立血透患者血管通路的良好方法，端侧吻合可以保证足够的血流量，又不阻断远端血流，应在建立血管通路时首选。对直接吻合失败。

Appropriate method for making arteriovenous fistula and treating the access complications.

Objective To achieve appropriate method for making arteriovenous fistula and treating the access complications.Methods We summarized 449 cases of arteriovenous fistulae performed on end stage renal disease (ESRD)patients by direct arteriovenous anastomosis and corpse.saphenous vein allograft.Most of the end(vein) to side anastomoses or end to end anastomoses were chosen between the radial artery and the cephalic vein on frearm.Occasionally end to side anastomosis or end to end anastomosis was done between the dorsal artery and the saphenous vein.The patients who met with fail ure in the fistulation by direct arteriovenous anastomosis or had poor vascular condition were subjected to corpse vascular graft.Results The arteriovenous fistulae could supply enough blood flow and had less complications.Effectiveness of successful fistulae after 4 years was up to 92%.Conclusion Direct arteriovenous anastomosis to for fistulization is the best method for ESRD patients.End to side anastomosis should be the first choice because it can supply enough blood flow during hemodialysis and keep free circulation of the blood.