3种血液透析动静脉内瘘手术方式的体会

目的通过血液透析动静脉内瘘术的3种手术方法，探讨不同方法的优势及手术相关技巧。方法总结该科施行动静脉内瘘术83例的临床资料，其中，上肢自体动静内瘘术74例，下肢自体动静脉内瘘术3例。人工血管移植动静内瘘术6例。结果74例上肢自体动静内痿术，成功69例（93．2％），失败5例（6．8％）；3例下肢自体动静脉内瘘术，成功1例（33．3％），失败2例（66．7％）；6例人工血管移植动静内瘘术。成功5例（83．3％），失败1例（16．7％）。该组83例病例中，总体的成功率：90．4％（75／83），失败率：9．6％（8／83）。患肢水肿7例，切口渗血3例，人工血管感染1例，淋巴瘘1例，无窃血综合征及心衰发生。结论上肢自体动静内瘘术，尤其是“鼻咽窝”处动静脉内瘘术是动静脉内瘘术的首选方法，下肢自体动静脉内瘘术及人工血管移植动静内瘘术可以作为候选方案。

Experience of three methods of arteriovenous fistulation for hemodialysis

Objective] To research and probe into the advantages and concerned operative skills of each method respectively. Method] It was to summarize the 83 cases clinical data of arteriovenous fistulation carried out in our section, in which, 74 cases were autoarteriovenous fistulations of the upper limb, 3 cases were autoarteriovenous fistulations of the lower limb, 6 cases were arteriovenous fistulations with artificial blood vessel transplantation. Results] In the 74 cases of autoarteriovenous fistulation of the upper limb, the success cases were 69(93.2%) ones, the failed cases were 5(6.8%)ones. In the 3 cases of autoarteriovenous fistulation of the lower limb, the success case was 1(33.3%), the failed cases were 2(66.7%)ones. In the 6 arteriovenous fistulations with artificial blood vessel transplantation, the success cases were 5(83.3%)ones, the failed case was 1(16.7%). In this group of 83 cases, the total success rate was 90.4%(75/83), the failed rate was 9.6%(8/83). And limb edema was 7 cases, incision hemorrhage were 3 cases, artificial blood vessel infection was 1 case, lymphatic fistula was 1 case, there were not cases of arterial steal syndrome and heart failure. Conclusion] Autoarteriovenous fistulation of the upper limb, especially for arteriovenous fistulation from the place of snuffbox which is the preferred method for arteriovenous fistulation, and autoarteriovenous fistulation of the lower limb and arteriovenous fistulation with artificial blood vessel transplantation can be as candidate operative methods.