动静脉内瘘术中血管吻合困难的原因及对策  

The Cause of Difficult vascular anastomosis in arteriovenous internal fistula formation and the countermeasures

作　　者：张凡[1] 郭东阳[1] 王涛[1] 崔建强[1] 陈昭颉[1] 

机构地区：[1]成都军区总医院肾内科,成都610083

出　　处：《成都军区医院学报》2003年第1期1-2,4,共3页

摘　　要：目的 总结尿毒症患者动静脉内瘘术中血管吻合困难的原因,评价针对不同原因所采取的对策。方法 查询手术记录并统计血管吻合困难的原因、术者采取的对策及手术成功率,数据进行统计学处理。结果 血管吻合困难常见原因为血管硬化和细小、静脉回流不畅、血管管径相差太大及血管相距较远,针对前二种原因,本组分别采三种不同的对策,导致了不同的成功率,针对后二种原因本组采取的对策结果无明显差别。结论 血管吻合困难的原因最常见为血管腔径过小,采取对点等距切开血管断端后行钛轮钉吻合,成功率较高;对于静脉回流不畅采取无损伤针头伸入血管,以肝素盐水冲洗后再行吻合,成功率较高;针对血管管径相差太大可通过切断血管时调整斜面大小或行端侧吻合;血管相距太远可选择对应血管或采取移植血管吻合。Objective To study the cause of difficult vascular anastomosis in arteriovenous internal fistula formation for uremia patients and various countermeasures. Methods Statistical analysis was carried out to the data gained from the study of the causes of difficult vascular anastomosis, the countermeasures adopted in operation and the rate of success. Results The common causes for difficult vascular anastomosis are arteriosclerosis, obstructed venous return, great differences in blood vessel calibers and distant position between the blood vessels. We adopted 3 different countermeasures for the first two causes with different rate of success, while the countermeasures adopted for the last two causes showed no significant different results. Conclusions Smaller blood vessel calibers result most commonly in difficult vascular anastomosis, a higher rate of success can be gained by anastomosis with titanium circumpin on the blood vessel ends being cut point - to - point at the same distance, while for the case of obstructed venous retum, anastomosis can produce a higher rate of success when performed after putting intact needles into the blood vessels first and then washing with heparin saline; when the difference between the blood vessels calibers is too big, the size of the slope should be adjusted when cutting off the blood vessels,or an end - to - side anastomosis should be carried out;for vessels with distance in between , anastomosis may be performed on the chosen correspondent blood vessels, or just on the transplanted blood vessels.

关 键 词：动静脉内瘘 手术 血管吻合 血液透析 肾功能衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]