50例球囊扩张下动静脉内瘘术的临床效果评价

目的：探讨球囊扩张下血液净化用前臂动静脉内瘘术的手术方法以及临床效果。方法：总结暨南大学附属第一医院肾内科2005年7月～2012年1月收治的50例诊断明确的尿毒症患者因需要长期透析以及血管条件差而行球囊辅助下前臂动静脉内瘘术。手术选择病人的非主力手,分别游离头静脉和桡动脉,结扎头静脉的远端向头静脉和桡动脉的近端分别插入动脉取栓导管并用2ml注射器向导管内注入适量肝素生理盐水,充起球囊,根据需要持续均匀的扩张头静脉和桡动脉的狭窄段,再以7-0的血管逢线端侧吻合血管。结果：术后即时、1、2、3h、术后连续7d均能听到血管杂音以及扪及到血管震颤平均随访60个月手术的成功率90%以上。已有30例病人内瘘成熟并已使用超过3年以上,内瘘的血流量均大于250ml/min,完全能满足各种血液净化治疗的需要。结论：球囊辅助下前臂动静脉内瘘术手术成功率高,可以纠正动静脉血管条件差伴有部分狭窄的患者,内瘘成熟快,血流量大,临床效果好。

50 Cases of Balloon Dilatation of Internal Arteriovenous Fistula Clinical Effect Evalution

Objective:In order to evaluate the operation methods and the clinical effect of the forearm internal arteriovenous fistula for blood purification.Methods:From July 2005 to January 2012,we had summarized 50 patients with urinemia who received the forearm internal arteriovenous fistula by the catheter in the Department of Nephrology of the first affiliated hospital of Ji-nan University.We usually choose the nondominant arm to operate,after the distal of the artery and vein were ligated,we inserted the catheter into the proximal vessels to dilate the cephalic vein and/or the radial artery.We performed an end-to-side anastomosis with a 7-0monofilament suture.Results:We examined the AVF by palpation and auscultation just after operation、1、2、3 hour and continuous 7 days postoperatively.The mean length of follow-up was 60 months,The patency rate was over 90%,and 30 patients who received blood purification have used the autogenous radial-cephalic internal arteriovenous fistula over 3 years,The AVF blood flow was larger than 250 ml/min during blood purification.Conclusion:The autogenous radial-cephalic internal arteriovenous fistula operation by the catheter have a high achievement ratio,and the patency rate was 95%.The method is successful in overcoming the stenosis of the cephalic vein and/or the radial artery,and the patients gain a quit good clinical effect.