手术缩窄干预透析内瘘瘤样扩张的临床研究  

Clinical study of the narrowing operation in the treatment of patients with tumor-like dilatation of arteriovenous fistulas

作　　者：陆石[1] 韩国锋[1] 刘楠梅[1] 胡伟锋[1] 于秀峙[1] 王葳[1] 彭民[1] 张金元[1] 

机构地区：[1]解放军第四五五医院肾脏病科,上海200052

出　　处：《中国血液净化》2015年第12期746-749,共4页Chinese Journal of Blood Purification

摘　　要：目的 观察探讨内瘘缩窄术治疗上肢自体血管内瘘瘤样扩张的临床疗效.方法 自2010年1月～2015年5月,对因上肢自体内瘘发生瘤样扩张行手术缩窄治疗效果进行前瞻性临床观察,总结患者临床特点、手术方法及成功率、手术干预的适应证、缩窄手术干预的技术指标.术后随访,观察内瘘透析使用情况及临床症状的改善.结果 30例患者内瘘瘤样扩张多发生在1年以上,部位以透析穿刺点附近多见,内瘘缩窄手术的技术成功率为100％,3例伴内瘘瘤形成不适合做缩窄手术行部分切除和直接结扎术,1例在同侧利用贵要静脉重建内瘘,1例另侧肢体再建,1例改用带涤纶套导管留置.术后随访3～6个月,临床症状改善明显,内瘘扩张段的体表直径由术前的（43.075±1.332） mm缩小为（28.604±3.406） mm,差异具有统计学意义（t=9.943,P=0.001）;彩色多普勒超声测定其术后内瘘血液流速为（791.100±28.120） ml/min,较术前的内瘘流速（1987.000±53.730） ml/min下降60％～70％ （t=19.720,P=0.001）,术后4～8周均重新用于透析.结论 对于内瘘瘤样扩张采用缩窄手术治疗是一个非常有效的干预方法.Purpose To investigate the clinical effect of narrowing operation on the patients with tumorlike dilatation of arteriovenous fistula （AVF）. Methods Patients with tumor-like dilatation of AVF from Jan. 2010 to May 2015 were included in this study. We summarized their clinical characteristics, surgical methods, indication of the surgical intervention, and technical indication of the surgical intervention. After narrowing operation, clinical symptoms of the patients were also observed. Results Thirty patients were included in this study. Tumor-like dilatation of AVF occurred for more than one year in all of the 30 cases. Dilated AVFs located near the puncture sites. The successful rate of this operation was 100%. Three patients were unsuitable for this operation and were treated with ligation. Among the 3 patients, the AVF was reconstructed using basilica vein in one patient, the AVF was changed to another limb in one patient, and a polyester cuffed catheter was indwelled in the fistula in one patient. Clinical symptoms improved significantly in the follow-up period of 3- 6 months. The diameter of AVFs reduced from 43.0754-1.332 mm to 28.604-3.406 mm （P=0.001）. Blood flow velocity measured by color Doppler ultrasound decreased by 60% -70% （from 1987.0- 53.73 ml/min to 791.10-28.12 ml/min, P〈0.01）. Reconstructed AVFs were used for blood access again after 4-8 weeks of operation. Conclusions The narrowing operation is an effective intervention for the tumor-like dilatation of AVF.

关 键 词：手术缩窄术 血液透析 自体动静脉内瘘 瘤样扩张 

分 类 号：R318.16[医药卫生—生物医学工程]