终末期肾病自体动静脉内瘘术后狭窄的手术修复策略.pdfVIP

1538· · doi 10.3969/j.issn. 1673-4254.2013.10.28 J South Med Univ, 2013, 33(10): 1538-1540 技术方法 终末期终末期肾病自体动静脉内瘘术后狭窄的手术修复策略肾病自体动静脉内瘘术后狭窄的手术修复策略 周忠信，潘春球 南方医科大学南方医院血管外科，广东 广州 510515 摘要：目的探讨终末期肾病（ESRD）患者自体动静脉内瘘（AVF）狭窄的手术修复方法和疗效。方法本院近3 年415 例ESRD 患 者29 例12月内发生AVF 狭窄，Ⅰa 型5 例，Ⅰb 型17例，Ⅱ型3 例，Ⅲ型2 例。5 例Ⅰa 型于桡动脉近心端重置吻合。17例Ⅰb 型 截取副头静脉间置狭窄（5例）或转位替代狭窄（12例）以重建头静脉。3例Ⅱ型中1例截取副头静脉间置于头静脉，1例截取大隐 静脉间置于吻合口与肘正中静脉，1例以前臂贵要静脉与桡动脉重置吻合。2 例Ⅲ型中1例以前臂贵要静脉与桡动脉重置吻合， 1例改为对侧桡动脉-头静脉内瘘术。结果29 例患者28 例适合修复并成功（96.6% ，28/29），1例术后12 h 血栓形成，急诊取栓重 置吻合；2 例术后9 月再狭窄，予以分期球囊扩张（PTA）后恢复，12月内再狭窄发生率7.1%(2/28)。28 例AVF 修复ESRD 患者均 完成12月规律HD。结论重建吻合口、选择合适的自体血管替代狭窄节段或以前臂贵要静脉作为透析通道能使大多数AVF 狭 窄得以修复后继续使用。 关键词：自体动静脉内瘘；狭窄；修复；终末期肾病 Surgical strategy for management of postoperative stenosis of ateriovenous fistula in patients with end-stage renal disease ZHOU Zhongxin, PAN Chunqiu Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Abstract: Objective To explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula (AVF) in patients with end-stage renal disease (ESRD). Methods Of the 415 patients with ESRD receiving radial-cephalic end-to-side anastomosis during the last 3 years, 29 developed postoperative AVF stenosis (of type Ia in 5 cases, type Ib in 17 cases, type II in 3 cases, and type II in 2 cases). A proximal anastomosis was created between the radical artery and cephalic vein for type Ia stenosis. In the 17 cases with type Ⅰb stenosis, 5 were managed by interception of suitable segments from the accessory cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, 1 by interception