肘正中静脉穿通支在建立困难血液透析通路中的超声影像解剖及其临床应用  

Ultrasonic imaging anatomy and clinical application of perforating branch of median cubital vein in establishing tough hemodialysis access

作　　者：付强 王康 郭宝春 魏章洪 刘兆康 黄杰滔 庄永青 FU Qiang;WANG Kang;GUO Baochun;WEI Zhanghong;LIU Zhaokang;HUANG Jietao;ZHUANG Yongqing(Department of Hand Microsurgery and Vascular Surgery,Shenzhen People’s Hospital,Shenzhen,Guangdong Province 518020,China;Department of Nephrology’s Blood Purification Room,Shenzhen People’s Hospital,Shenzhen,Guangdong Province 518020,China;Department of Ultrasonic Imaging,Shenzhen People’s Hospital,Shenzhen,Guangdong Province 518020,China)

机构地区：[1]深圳市人民医院手显微血管外科,518020 [2]深圳市人民医院肾内科血液净化室,518020 [3]深圳市人民医院超声科,518020

出　　处：《中华显微外科杂志》2020年第3期272-276,共5页Chinese Journal of Microsurgery

基　　金：深圳市医疗卫生"三名"工程项目(SZSM201512032)。

摘　　要：目的研究肘正中静脉穿通支的CDU影像解剖学特点及其临床应用,为利用肘部穿通支静脉建立高位血液透析通路的可行性找到依据。方法2016年11月至2019年10月,应用CDU检查75例成年人的150侧肘正中静脉,测量穿通支长度和内径,对肘正中静脉穿通支进行超声影像解剖学分型;对其中38例前臂造瘘困难的慢性肾衰患者采用肘正中静脉穿通支-肱(桡)动脉吻合的方法建立血液透析通路,观测瘘管血流量,记录瘘管成熟时间,测量有效血管长度,得出长期使用率。结果肘正中静脉穿通支位置恒定,出现率为94.0%,靠近肱动脉,多于静脉汇合处发出,超声影像解剖可分4型,各型之间的血管长度和血管内径无明显差异(P>0.05);38例患者内瘘成熟后均可满足血液透析需求,I型和II型患者瘘管的有效血管长度优于III型(P<0.01),3型患者瘘管的长期使用率分别是84.6%、85.7%和72.7%。各型之间的瘘管血流量和成熟期差异无统计学意义(P>0.05)。结论肘正中静脉穿通支高位造瘘术安全可靠,以I型和II型最优,可以为前臂血管耗竭、高龄糖尿病肾病以及瘘管血栓复通失败的困难造瘘患者提供一个安全高效的血液透析通路。Objective To explore the characters of CDU imaging anatomy and results of clinical application of perforating branch of median cubital vein,and to find the evidence of utilizing perforating vein to establish high level hemodialysis access.Methods From November,2016 to October,2019,150 median cubital veins in 75 persons were observed by CDU.And the inner diameter and length of the perforating branch were measured Perforating branches of median cubital vein were categorized with ultrasonic imaging anatomy.Thirty-eight chronic kidney failure patients who can not build forearm fistulas were operated by end-to-side anastomosis between perforating branch vein and brachial artery to build hemodialysis access.The blood flow of fisultas was measured,the mature period of fisultas was recorded.The length of available vessels of fisultas was measured and the long-term utilization rate of fisultas was counted.Results Perforating branch of median cubital vein was always located in a little below elbow near brachial artery,the rate of occurrence was 94.0%.It was sent out at intersection of veins.There were 4 types of perforating vein in image-anatomy.There was no significant difference in vessel length and vessel inner diameter between different types(P>0.05);All the 38 patients with mature fistulas could meet the needs of hemodialysis.The available vascular length of fistulas in type I and type II patients was better than that in type III(P<0.01),and the long-term utilization rates of fistulas in type I,type II and type III were 84.6%,85.7%and 72.7%,respectively.There was no significant difference in blood flow and mature period between different types(P>0.05).Conclusion It is most safe and reliable to use the type I and type II of perforating branch of median cubital vein to make the high level fistulas,which can provide a safe and efficient hemodialysis access for the patients with forearm vascular drain,elderly diabetes patients and difficult fistulas with repeatedly thrombosis.

关 键 词：肘正中静脉 穿通支 血液透析 造瘘 超声影像解剖 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]