小血管套叠粘接吻合法在血液透析者中建立动静脉内瘘的应用  

TELESCOPIC ADHESIVE ANASTOMOSIS OF SMALL BLOOD VESSEL APPLIED IN FORMATION OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS/

作　　者：沈干[1] 冷永成[1] 荣国华[1] 黄金龙[1] 

机构地区：[1]南京铁道医学院附属医院整形外科

出　　处：《中国修复重建外科杂志》1997年第2期121-123,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：慢性肾病患者常需要建立动静脉内瘘进行透析，常规间断缝合法吻合动静脉难度大、耗时长。为了缩短吻合时间，提高远期通畅率，进行了套叠粘接吻合法建立动静脉内瘘的实验研究，并将这一方法应用于透析患者建立动静脉内瘘的血管吻合。将动脉端套入静脉端，只需吻合两针，用医用胶封闭吻合口。经８个月观察，通畅率达１００％，血流量均超过３００ｍｌ／ｍｉｎ。达到了透析需要。The formation of an arteriovenous fistula for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40±0.20 mm (radial artery) or 2.40±0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180° apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thicknees of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so formed fistula would fulfill the need of hemodialysis.

关 键 词：血液透析 动静脉内瘘 小血管吻合 医用粘合胶 

分 类 号：R459.5[医药卫生—治疗学]