前臂贵要静脉转位建立动静脉内瘘在透析患者中的应用探讨  

Discussion on the application of transposition of forearm basilic vein in the establishment of arteriovenous fistula in dialysis patients

作　　者：颜建华[1] 张以勤[1] 陈燕真[1] 玄先法[1] 王玉新[1] YAN Jianhua;ZHANG Yiqin;CHEN Yanzheng;XUAN Xianfa;WANG Yuxin(Department of Nephrology, Xiamen No.2 Hospital, Xiamen Medical College Affiliated Hospital, Xiamen 361021, China)

机构地区：[1]厦门市第二医院厦门医学院附属医院肾内科,福建厦门361021

出　　处：《中国现代医生》2017年第30期74-77,共4页China Modern Doctor

基　　金：福建省卫生系统中青年骨干人才培养项目(2014-ZQN-JC-44)

摘　　要：目的探讨非常规自体动静脉内瘘建立困难下经前臂贵要静脉转位术内瘘的建立意义。方法对本院2014年2月~2016年8月常规内瘘建立困难患者14例采用前臂贵要静脉转位建立非常规自体动静脉内瘘,与行高位瘘对比,可明显增加可利用血管长度,总结接受这一手术患者节约静脉资源情况的临床资料。结果 14例接受该手术方式的患者手术均一次性成功,术后通畅良好,术后6~8周穿刺使用率为100%,透析血流量在180~250 m L/min。观察内瘘应用中均未发生窃血综合征、肿胀手综合征及肢体缺血等严重并发症,对患者的心功能未造成不良影响。结论大多数的常规内瘘建立困难患者利用前臂贵要静脉进行转位建立自体动静内瘘在技术上是可行的,有效利用了前臂的血管资源,是对上臂静脉宝贵资源的开发与利用,不失为良好的优先于高位内瘘和血管移植内瘘选择。Objective To investigate the significance of establishment of fistula via transposition of forearm basilic vein due to difficult establishment of non-conventional autologous arteriovenous fistula. Methods From February 2014 to August 2016, 14 patients with difficult establishment of conventional fistula were given transposition of forearm basilic vein for the establishment of non-conventional autologous arteriovenous fistula. Compared with the high fistula, the length of available blood vessels could be significantly increased. The clinical data of the patients who received the surgery and saved the intravenous resources were summarized. Results 14 patients who were given the surgical proce-dure were successful at the first time, and the vascular patency was favorable after the surgery. The application rate of puncture 6 to 8 weeks after surgery was 100%, and steal syndrome, the dialysis blood flow was 180-250 mt/min. During the application of fistula, stealing syndrome, swelling hand syndrome and limb ischemia and other serious complications were not detected, and patients＇ heart function was not adversely affected. Conclusion Transposition of forearm basilic vein for the establishment of autologous arteriovenous fistula in most of the patients with difficult establishment of con-ventional fistula is feasible technically, which effectively uses of the forearm vascular resources and is the development and utilization of the valuable resources of the forearm vein. It is a favorable selection better than high fistula and vas-cular graft fistula.

关 键 词：贵要静脉转位 动静脉内瘘 血管通路 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]