肘下高位动静脉内瘘术的临床应用.PDFVIP

·128· 中国血液净化2012年3月第11卷第3期 Chin J Blood Purif, March, 20 12, Vol.11, No.3 ·临床研究 · 肘下高位动静脉内瘘术的临床应用 郭相江 施亚雪 张 皓 梁 卫 赵意平 张 岚 薛冠华 张纪蔚 张柏根 【摘要】目的 探讨肘下高位动脉静脉内瘘的手术方法及临床效果。 方法 回顾性分析仁济医院血 管外科行肘下高位动静脉内瘘术的治疗效果，通畅率及并发症。 结果 自2005年10月至2010年12月 行近端桡动脉或尺动脉-肘正中静脉或交通支静脉吻合建立动静脉内瘘病例共计62例，男性41例，女 性21例，平均年龄(56.06±17.83)岁，全部病例手术成功，无血肿、感染等并发症，无围手术期 死亡，术后1～2月开始穿刺行血液透析。术后1年、2年通畅率分别为98.1%及96.3%。无明显心 力衰竭及窃血综合征发生。 结论 肘下高位动静脉瘘具有手术创伤小，血液透析径路长，手术成功 率、通畅率高，术后心力衰竭，窃血综合征以及肢体肿胀发生率低的优点，是一种值得临床推广的 手术方式，可代替肘上高位作为血管通路手术的第二选择。 【关键词】肘下;动静脉瘘;临床应用 中图分类号：R318.16文献标识码： Clinical application of below-the-elbow arterio-venous fistulas GUO X iang-j iang, SHI Ya-xue, ZHAN G Hao, LIAN G Wei, ZHA O Yi-p ing, ZHAN G Lan, X UE Guan-hua, ZHAN G Ji-wei, ZHAN G Bai-gen. Dep artment of Vascular Surgery, Shanghai RenJi Hosp ital, Shanghai 200001, China Corresp onding author: SHI Ya-xue, Email:shiy qxue@y 【Abstract 】Obj ectives To summarize our experience about the operation method for below-the-elbow arterio-venou s fistulas (BEAVFs) and its clinical effects. Methods We retrospectively analyzed the maturation, patency and complications of the BEAVFs performed between October 2005 and December 20 10 in this department. Results A total of 62 cases (4 1 males and 2 1 females; mean age 56.06 ±17.83 yrs) were treated with the anastomosis of proximal radial (or ulnar) artery and the median cubital vein (or its perforator vein). BEAVFs were successfully established in all patients without complications including hematoma, wound infection, high output cardiac failure, steal blood syndrome and perioperative mortality. The BEAVFs were functionally u seful for hemodialysis access after the operation for 1-2 months. After the operation for one and two years, the patent rate was 98.1% and 96.3%, respectively. Conclusions BEAVF is a new method better than the brachial artery in- flow AVF.