自体股部大隐静脉移植内瘘临床应用分析

摘要

Objective To evaluate the usefulness ofarteriovenous fistula in an upper extremity constructed by using great saphenous vein autograft for blood access in hemodialysis. Methods A total of 12 patients with end stage renal disease were observed. Their fistulas were difficult to be constructed using the local vessels, but their great saphenous veins were patent on ultrasound examination. We connected brachial artery or radial artery to the great saphenous vein autograft, which then passed through the forearm subcutaneous tissue in straight or U profile,and end-to-side anastomosed to median cubital vein, cephalic veins or basilic vein. The inner diameters of anastomosis stomas and autografted vein were measured at different period. Blood flow in hemodialysis was recorded, and Kt/V was calculated. Results Operation for fistula construction was successful without any complication such as infection or hematoma. Thrombosis occurred in 2 patients after the operation for 2.5 months and 3 months,respectively. The inner diameter of the stoma was 0.48±0.06cm at the arterial end, and was 0.52±0.10cm at the venous end. Blood flowduring hemodialysis was 270.8±32.0ml/min, and Kt/V was 1.65±0.19. The average expense of this surgical operation was 1807 yuan/patient. Conclusion Arteriovenous fistula in an upper extremity constructed by using autograft of great saphenous vein for blood access is associated with rare complications, higher patency rate for a long period of time, sufficient blood flow during hemodialysis, and less expense for the operation.This operation can be used in patients with inadequate vascular access.%目的 探讨自体大隐静脉上肢移植内瘘的建立方法,观察其临床应用价值.方法 选择北京市海淀医院肾内科12名终末期肾脏病患者,经超声检查证实上肢无合适血管建立动静脉内瘘,且超声提示股部大隐静脉通畅.吻合动脉采用上肢肱动脉或桡动脉,静脉为肘正中静脉、头静脉或贵要静脉,J形或U形搭桥术式端侧吻合.观察动脉吻合口、静脉吻合口及移植静脉不同时段的内径,观察血液透析泵控血流量并计算透析充分性.结果 所有患者内瘘术后全部即刻畅通,术后未见感染、血肿等并发症,1例患者于内瘘术后2.5月血栓形成并堵塞,1例于3月时堵塞.术后15d时动脉吻合口、静脉吻合口的内径分别为0.48±0.06cm、0.52±0.10cm(配对t 检验,P=0.045);透析泵控血流量(内瘘使用1月)为270.8±32.0ml/min,尿素清除指数(K t/V)为1.65±0.19,尿素清除率75.3%±3.3%.手术平均花费为人民币1807元.结论 大隐静脉移植上肢内瘘术后并发症少,长期通畅率高,易于护理操作,透析充分性好,总体费用低,可作为难以建立透析通路患者的一种有效的血管通路.