超声引导下改良MILLER手术在血液透析高流量自体动静脉内瘘限流中的应用  

Application of modified MILLER operation guided by ultrasound for flow restriction of high-flow autologous arteriovenous fistula in hemodialysis

作　　者：白培进 周凌辉[1,2] 张佐炳 张俊[1,2] 贺德刚[1,2] 胡伟平[1,2] 杨厦黎[1,2] 黄继义 BAI Pei-jin;ZHOU Ling-hui;ZHANG Zuo-bing;ZHANG Jun;HE De-gang;HU Wei-ping;YANG Xia-li;HUANG Ji-yi(Department of Nephrology,the First Affiliated Hospital of Xiamen University,Xiamen 361000,China;The Third Clinical Medical College of Fujian Medical University,Fuzhou 350108,China;Department of Ultrasound,the First Affiliated Hospital of Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院肾内科,厦门361000 [2]福建医科大学第三临床医学院,福州350108 [3]厦门大学附属第一医院超声科,厦门361000

出　　处：《中国血液净化》2022年第3期206-209,共4页Chinese Journal of Blood Purification

摘　　要：目的探索一种简单有效的对高流量自体动静脉内瘘进行限流的手术方式。方法回顾性分析厦门大学附属第一医院肾内科2016年1月~2020年12月对高流量自体动静脉内瘘在超声引导下使用改良MILLER手术进行动脉限流患者共12例,手术前内瘘均进行彩超检查,手术中使用泰尔茂6F血管鞘芯置于距瘘口2cm的近端动脉表面,用7号丝线套圈2处,并于手术中实时彩超监测,通过调节丝线套圈的松紧度使肱动脉流量在800~1000ml/min,于手术当天、手术后3个月及手术后6个月复查内瘘彩超。结果①手术后套圈处动脉的平均直径较手术前缩小[(3.32±0.28)比(4.85±0.35)mm,t=20.282,P=0.001],手术后套圈处动脉直径分别与手术后3个月(t=-1.295,P=0.209)及手术后6个月(t=-1.342,P=0.193)比较差异均无统计学意义。②手术后肱动脉流量较手术前下降,[(913±33)比(1905±243)ml/min,t=13.923,P=0.001],手术后3个月(t=-0.364,P=0.719)及手术后6个月(t=-0.806,P=0.429)复查肱动脉流量与手术后比较差异无统计学意义。结论超声引导下改良MILLER手术在超声引导下套圈精确,可以对高流量动静脉内瘘进行有效限流,手术后内瘘血流量稳定,术式简单易做,安全有效,花费低,值得推广。Objective To explore a simple and effective operation to limit the flow of high-flow autogenous arteriovenous fistula(AVF).Methods A total of 12 patients with high-flow AVF treated in the Department of Nephrology,the First Affiliated Hospital of Xiamen University from January 2016 to December 2020 using modified MILLER surgery under ultrasound guidance to limit arterial flow were retrospectively analyzed.These AVFs underwent color Doppler ultrasound examination before operation.During the operation,the core of Terumo 6F vascular sheath was placed on the surface of the proximal artery 2 cm away from the fistula,and the sheath core was looped with a slipknot using a 7-gauge silk thread;there were two ferrules with an average interval of 1cm;color Doppler ultrasound monitors the artery diameter and brachial artery flow at the ferrule,and the tightness of the silk loop was adjusted to make the brachial artery flow within 800-1000 ml/min.Color Doppler ultrasound examination for the AVF was repeated on the day after operation,3 months after the operation,and half a year after the operation.Results The average diameter of the artery after the operation was significantly reduced compared with that before the operation(t=20.282,P=0.001).The artery diameter at the ferrule was rEexamined after the operation for 3 months and half a year,and the two values had no statistical significance(t=-1.295,-1.342;P=0.209,0.193).The blood flow in the brachial artery after the operation was significantly lower than that before the operation(t=13.923,P=0.001).The postoperative blood flow in the brachial artery was rEexamined after the operation for 3 months and half a year,and the two values had no statistical significance(t=-0.364,-0.806;P=0.719,0.429).Conclusion The modified MILLER operation under ultrasound guidance can accurately adjust the ferrules to effectively limit the flow in highflow AVF.The postoperative blood flow in the AVF was stable.This surgical method is simple,easy to perform,safe,effective,low cost,and worthy of promot

关 键 词：动静脉内瘘 血液透析 高流量 手术 

分 类 号：R318.16[医药卫生—生物医学工程]