65例人工血管动静脉内瘘的临床经验  

Cliniacal experience of arterio-venous grafts:a report of 65 cases

作　　者：刘池拽[1] 师天雄[1] 胡锡祥[1] 缪健航[1] 

机构地区：[1]中山市人民医院中山大学附属中山医院血管外科,广东中山528400

出　　处：《中国血管外科杂志（电子版）》2015年第4期259-262,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结为不适合行自体动静脉内瘘患者建立人工血管动静脉内瘘的临床经验。方法对2009年1月至2014年12月65例行人工血管动静脉内瘘成形术患者的病例资料进行回顾性分析,其中慢性肾小球肾炎15例,糖尿病性肾病27例。手术方法是前臂人工血管动静脉内瘘成形术和上臂人工血管动静脉内瘘成形术。结果 65例患者共行动静脉内瘘手术71次,全部成功,总体成功率100%。术后有69例次成功用于透析穿刺,内瘘成熟率97%。围手术期最常见的并发症为上肢肿胀(58例),其次为血栓形成(3例),出血(2例),缺血性神经病变(2例),窃血综合征(1例),切口血清肿(1例)。结论对不适合行自体动静脉内瘘的患者建立人工血管动静脉内瘘是可行的,术前予以积极准备及评估血管可提高成功率、减少并发症。Objective To summary the clinical experience of establishing arterio-venous graft for patients without suitable blood vessels for autologous arteriovenous fistula.Method The clinical data of 65 patients without suitable blood vessels for autologous arteriovenous fistula and established arterio-venous graft from January 2009 to December 2014 were analyzed retrospectively.Twenty-seven patients were diabetic nephropathy,15 patients were chronic glomerulonephritis.Arterio-venous grafts were operatively placed in the upper extremity,including loop graft in forearm and loop graft in upper arm.Results A total of 71arterio-venous grafts were successfully placed in 65 patients with surgical success rate of 100% and internal fistula maturation rate of 97%.During perioperative period,the common complication was edema of upper extremity(58 cases),thrombosis(3 cases),hemorrhage(2 cases),upper extremity ischemic neuropathy(2cases),upper artery steal syndrome(1 case)and serous leak(1 case).Conclusion To establish arteriovenous graft for patients without suitable blood vessels for autologous arteriovenous fistula was feasible,optimal preparation and evaluation of blood vessels before operation may improve the operation success rate and reduce the complications.

关 键 词：人工血管动静脉内瘘 终末期肾病 

分 类 号：R473.5[医药卫生—护理学]