腕上桡动脉血液透析穿刺致假性动脉瘤的治疗回顾分析  

A retrospective analysis of the treatment of wrist radial artery pseudoaneurysms induced by puncture for hemodialysis

作　　者：温国贤[1] 黄军成[1] 朱震平[1] 

机构地区：[1]广东省农垦中心医院外一科,湛江524002

出　　处：《中国实用医刊》2013年第22期56-57,共2页Chinese Journal of Practical Medicine

摘　　要：目的探求血液透析直穿致腕上桡动脉假性动脉瘤手术的同时，最大程度使用血液透析可用血管一期行动静脉内瘘，从而增加透析可用血管的储备，达到提高患者生存率和生活质量的目的。方法总结农垦中心医院对133例桡动脉假性动脉瘤患者的治疗经验并进行分析，找出手术最佳方法与疗效的关系，除9例感染性假性动脉瘤瘤体破裂出血抢救患者生命的同时急诊手术，其他均择期手术，106例切除瘤体同时行一期头静脉-桡动脉吻合内瘘成形术。结果133例中9例瘤体破裂出血休克，急诊手术抢救患者生命，2例抢救无效死亡；106例并一期行内瘘成形术，占手术总数的79．7％；术后平均随访（16．0±0．5）个月，93例内瘘成熟后血流能满足血液透析需要，成功率为87．7％。结论对血液透析直穿致腕上桡动脉假性动脉瘤治疗不能满足于流体切除加血管重建，大部分患者切除瘤体同时可一期行内瘘成形术，能充分使用血液透析可用血管，成功率较高，是有效可行的方法。Objective To study that at the same time of wrist radial artery pseudoaneurysm sur- gery induced by direct puncture for hemodialysis, pe^orm one-stage internal arteriovenous fistula with the use of a hemodialysis available vascular at maximum degree, thereby increase available reserves for vas- cular dialysis, to improve the patients survival and quality of life. Methods The treatment experience of 133 cases of radial artery pseudoaneurysm in our hospital were concluded and analyzed, and the relation- ship between best surgery method and effect was identified. For 9 infectious radial artery pseudoaneurysm cases with tumor rupture, emergency surgeries were performed at the same time of saving the patient＇ s life, while for others elective surgeries were performed. For 106 cases, one-stage cephalic vein-radial ar- tery anastomosis fistula angioplasty at in parallel with removal of the tumor was performed. Results In 133 cases, shock occurred in 9 cases due to tumor rupture, emergency surgery was performed to save the patient＇ s life, two died; fistula angioplasty in parallel was performed in 106 cases, accounting for 79.7% of the total number of surgeries; the follow-up time was（ 16.0 ±0. 5） months on average, for 93 cases, blood flow can meet the need of hemodialysis after fistula mature, the success rate was 87.7%. Conclusions In treatment of wrist radial artery pseudoaneurysm induced by direct puncture for hemodi- alysis, we cannot be satisfied with the fluid resection and revascularization, performed one-stage fistula angioplasty in parallel with removal of the tumor can be for most patients to make full use of hemodialysis available vascular, the success rate is high. It is an effective and feasible method.

关 键 词：桡动脉 血液透析 假性动脉瘤 动静脉内瘘 血管储备 

分 类 号：R459.5[医药卫生—治疗学]