终末期肾病自体动静脉内瘘术后狭窄的手术修复策略  

Surgical strategy for management of postoperative stenosis of ateriovenous fistula in patients with end-stage renal disease

作　　者：周忠信[1] 潘春球[1] 

机构地区：[1]南方医科大学南方医院血管外科,广东广州510515

出　　处：《南方医科大学学报》2013年第10期1538-1540,共3页Journal of Southern Medical University

基　　金：广东省自然科学基金(S2011010003908);广东省科技计划项目(2011B061300022);广东省医学科研基金(A2012356)

摘　　要：目的探讨终末期肾病(ESRD)患者自体动静脉内瘘(AVF)狭窄的手术修复方法和疗效。方法本院近3年415例ESRD患者29例12月内发生AVF狭窄,Ⅰa型5例,Ⅰb型17例,Ⅱ型3例,Ⅲ型2例。5例Ⅰa型于桡动脉近心端重置吻合。17例Ⅰb型截取副头静脉间置狭窄(5例)或转位替代狭窄(12例)以重建头静脉。3例Ⅱ型中1例截取副头静脉间置于头静脉,1例截取大隐静脉间置于吻合口与肘正中静脉,1例以前臂贵要静脉与桡动脉重置吻合。2例Ⅲ型中1例以前臂贵要静脉与桡动脉重置吻合,1例改为对侧桡动脉-头静脉内瘘术。结果 29例患者28例适合修复并成功(96.6%,28/29),1例术后12 h血栓形成,急诊取栓重置吻合;2例术后9月再狭窄,予以分期球囊扩张(PTA)后恢复,12月内再狭窄发生率7.1%(2/28)。28例AVF修复ESRD患者均完成12月规律HD。结论重建吻合口、选择合适的自体血管替代狭窄节段或以前臂贵要静脉作为透析通道能使大多数AVF狭窄得以修复后继续使用。Objective To explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula （AVF） in patients with end-stage renal disease （ESRD）. Methods Of the 415 patients with ESRD receiving radial-cephalic end-to-side anastomosis during the last 3 years, 29 developed postoperative AVF stenosis （of type Ia in 5 cases, type Ib in 17 cases, type II in 3 cases, and type II in 2 cases）. A proximal anastomosis was created between the radical artery and cephalic vein for type Ia stenosis, in the 17 cases with type I b stenosis, 5 were managed by interception of suitable segments from the accessory cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, I by interception of the distal great saphenous vein for interposing into the cephalic vein, and 1 by transposition of the forearm basilic vein for end-to-side anastomosis with the radial artery. The 2 cases with type III were managed by end-to-side anastomosis between the forearm basilic vein and the radial artery or by conversion to AVF repair on the contralateral forearm. Results Twenty-eight of the 28 patients finally received surgical repair of AVF stenosis and the surgeries were completed successfully. Thrombosis of the outflow vein occurred 12 h after the repair in 1 case to require emergency embolectomy and anastomosis; restenosis occurred in 2 cases at 9 months postoperatively, for which progressive percutaneous transluminal angioplasty （PTA） was performed. The rate of restenosis was 7.1% （2/28）. All the 28 patients undergoing AVF stenosis repair had successful HD for 12 months after the operation. Conclusion Reconstructing the arteriovenous anastomosis, replacing the stenosis segment with an accessory cephalic vein or great saphenous vein graft, or altering the outflow with the forearm basilic vein can be surgical options for repairing p

关 键 词：自体动静脉内瘘 狭窄 修复 终末期肾病 

分 类 号：R699[医药卫生—泌尿科学]