长段大隐静脉移植在动静脉内瘘术中的应用  

Application of great saphenous vein transplantation in arteriovenous fistulas

作　　者：李志勇[1] 宋润泽[1] 赵晶斌 王晶[2] 孔玉科[3] LI Zhi-yong;SONG Run-ze;ZHAO Jing-bin;WANG Jing;KONG Yu-ke(Department of Vascular Surgery,the Second Hospital of Lanzhou University,Lanzhou,Gansu 730030,China)

机构地区：[1]兰州大学第二医院血管外科,甘肃兰州730030 [2]兰州大学第二医院体检中心,甘肃兰州730030 [3]兰州大学第二医院肾病科,甘肃兰州730030

出　　处：《中国临床研究》2020年第2期226-228,共3页Chinese Journal of Clinical Research

摘　　要：目的观察自体长段大隐静脉移植人工内瘘术效果和优势。方法回顾性分析2016年2月至2017年7月收治的10例肾衰竭、上肢动脉条件不佳或长期使用后动静脉内瘘失功采用自体长段大隐静脉移植人工内瘘术患者的临床资料,总结手术经验,评价治疗效果。结果 10例患者中,初次内瘘手术1例,初次手术后早期闭塞而行2次重建者7例,长期使用失功、修复重造2例。行肱动脉-前臂静脉J型桥接7例(其中桥接头静脉5例,桥接贵要静脉2例),前臂引流静脉-静脉桥接3例。10例术中顺利,术后2~6周随访动静脉瘘功能良好;未发现严重并发症;内瘘手术直接相关费用远低于长期导管植入及人工血管移植内瘘费用;患者满意度高。结论小腿段长段大隐静脉移植前臂内瘘术可使部分行常规内瘘术困难或需再次修复内瘘的尿毒症患者获益,降低医疗费用,提高患者生活质量。Objective To observe the effect and advantage of self great saphenous vein transplantation for artificial internal fistula. Methods A retrospective analysis was performed in the clinical data of 10 patients treated with great saphenous vein transplantation for renal failure,poor condition of upper limb artery or loss of arteriovenous fistula function after long-term use from February 2016 to July 2017 to summarize the surgical experience and evaluate the therapeutic effect. Results Among the 10 operated patients,there were 1 case of the first internal arteriovenous fistula operation,7 cases treated with second reconstruction due to early occlusion after the first operation and 2 cases operated with repair and reconstruction because of loss-of-function after long-term use of internal fistula. In the operation of self great saphenous vein transplantation,J-type bridging of brachial artery with forearm vein was performed in 7 cases of(5 cases of bridging vein,2 cases of bridging basilic vein),and bridging of forearm drainage vein and vein was conducted in 3 cases. In 10 cases undergoing operation successfully,the function of arteriovenous fistula was good during postoperative 2-6 weeks follow-up with no serious complications. The direct cost of internal fistula operation was significantly lower than that of long-term catheter implantation and artificial blood vessel transplantation with high satisfaction in the patients. Conclusion Transplantation of long segment great saphenous vein into forearm internal fistula can benefit some uremic patients who have difficulty in routine internal fistula operation or need to reconstruct internal fistula,reduce the medical cost and improve the quality of life in the patients.

关 键 词：大隐静脉 动静脉内瘘 失功 移植内瘘 尿毒症 血液透析 肾衰竭 

分 类 号：R654.3[医药卫生—外科学]