22例导管扩张下动静脉内瘘术的临床效果评价  

作　　者：彭伟成 郑东文 唐爱当[2] 

机构地区：[1]广东省东莞市麻涌医院,523000 [2]东莞市人民医院肾内科

出　　处：《中国实用医药》2008年第23期59-60,共2页China Practical Medicine

摘　　要：目的探讨动脉取栓导管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。方法总结东莞市人民医院肾内科2006年1月至2008年1月收治的22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动脉取栓导管辅助下前臂动静脉内瘘术。手术选择患者的非主力手,分别游离头静脉和桡动脉,结扎头静脉和桡动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、1h、2h、3h、术后连续7 d均能听到血管杂音以及扪及到血管震颤平均随访8个月手术的成功率为95.5%以上。已有20例患者内瘘成熟并已使用,内瘘的血流量大于200ml/min,完全能满足各种血液净化治疗。结论动脉取栓导管辅助下前臂动静脉内瘘手术成功率高,可以纠正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。Objective In order to evaluate the operation methods and the clinical effect of the forearm internal arteriovenous fistula for blood purification. Methods From January 2006 to January 2008, we had summarized 22 patients with urinemia who received the forearm internal arteriovenous fistula by the catheter in the Department of Nephrology of the Peoples hospital of Dong Guan City. 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 7-0 monofilament suture. Results We examined the AVF by palpation and auscultation just after operation.1 hour、2 hour,3 hour and continuous 7 days postoperatively. The mean length of follow-up was 8 months, The pateney rate was 95 %, and 15 patients who received blood purification have used the autogenous radial-cephalic internal arteriovenous fistula, The AVF blood flow was larger than 200 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 quite good clinical effect.

关 键 词：动脉取栓导管 内瘘 临床效果 

分 类 号：R459.5[医药卫生—治疗学] R169.42[医药卫生—临床医学]