自体静脉移植建立的血液透析血管通路

背景：目前关于自体静脉移植建立内瘘的文章较少，尤其针对不同部位自体静脉移植效果的总结尚未见报道。目的：总结自体静脉移植内瘘的建立经验，探索提高手术成功率的方法。方法：回顾性分析40例自体静脉移植内瘘患者资料，对比上下肢静脉移植内瘘成功率、血流量和使用时间；分析合并糖尿病对自体静脉移植内瘘成功率的影响。结果与结论：自体静脉移植建立内瘘成功率由高到低依次为头静脉、大隐静脉、贵要静脉和小隐静脉；上肢移植静脉内瘘的血流量明显高于下肢移植静脉（P〈0.05）；比较使用时间，上肢移植血管内瘘长于下肢移植血管内瘘（P 〈0.01）；对于合并糖尿病的患者，进行自体血管移植的成功率明显低于不合并糖尿病者（P 〈0.01）。结果提示对于上肢浅静脉条件不佳的血液透析患者，自体静脉移植内瘘是其建立血管通路的较好方式；选择上肢静脉移植较下肢静脉移植内瘘的成功率高，使用时间长；而对于合并糖尿病的患者，不适宜行自体静脉移植内瘘。

Establishing a hemodialysis vascular access with autologous vein transplantation

BACKGROUND：Currently, literatures about autologous vein transplantation are few, and the research on the effect of different parts of autologous vein transplantation are not found yet. OBJECTIVE：To summarize the experiences of establishing the fistula using autologous vein transplantation so as to investigate the method of improving the success rate of surgery. METHODS：We analyzed retrospectively the data of 40 cases of establishing the fistula using autologous vein transplantation, and then compared the successful rate of autologous vein transplantation fistula, blood flow and operating time, thereby analyzing the influence of diabetes melitus on the successful rate of autologous vein transplantation fistula. RESULTS AND CONCLUSION：The successful rates of autologous vein transplantation fistula at different parts ranging from high to low were as folows： the cephalic vein, great saphenous vein, basilic vein and smal saphenous vein. Blood flow of the upper limb for vein transplantation fistula was obviously higher than that of the lower limb （P 〈 0.05）. The operating time of autologous vein transplantation fistula was longer in the upper limbs than in the lower limbs （P 〈 0.01）. For patients with diabetes melitus, the successful rate of autologous vein transplantation was markedly lower than those with no diabetes melitus （P 〈 0.01）. For the hemodialysis patients with poor upper limb superficial vein, autologous vein transplantation is a better way of establishing the vascular access. Vein transplantation of the upper limbs is better than that of the lower limbs in success rate and operating time. Autologous vein transplantation fistula is not suitable for the patients with diabetes melitus.