摘要
目的探讨穿静脉内瘘手术的建立方法和临床应用。方法收集2017年5月至2018年5月在中国人民解放军海军特色医学中心建立前臂穿静脉内瘘手术患者88例,男38例,女50例,年龄(59.0±11.9)岁,透析龄(37.6±54.4)月,其中穿静脉结扎侧侧吻合法74例,穿静脉切断端侧吻合法14例。结果87例手术一次性成功,1例失败。随访72例患者中有69例术后1~3个月内瘘成功用于透析穿刺,透析血流量(209.7±13.0)mL/min,2例因内瘘未成熟导致穿刺使用困难,1例在术后一个月意外死亡,在吻合口远端穿刺有39例,占56.52%。结论对于腕部及前臂中段血管条件差或因各种原因未达到标准而无法制作或重建理想内瘘的患者,选择建立前臂上段穿静脉内瘘,可以获得满意的临床效果。
Objective The purpose of this paper is to explore the establishment methods and clinical application of perforating-vein fistula surgery.Methods A total of 88 cases of patients undergoing forearm perforating-vein fistula surgery from May 2017 to May 2018 in our hospital were selected,including 38 males and 50 females,with an average age of(59.0±11.9)and average dialysis age of(37.6±54.4)months.There were 74 cases of anastomosis of the vascular side after ligation of perforating veins and 14 cases of vascular end-to-side anastomosis after cutting perforating veins.Results There were 87 patients with successful operations at a time and one with failing operation.At 1~3 months after operation,among 72 patients followed up,in 69 ones the established fistula was successfully used for dialysis puncture[dialysis blood flow(209.7±13.1 mL/min)]and in 2 ones the puncture had difficulty as the fistula was immature.One patient died unexpectedly one months after surgery.There were 39 cases of patients with puncture at the distal anastomosis,accounting for 56.52%.Conclusions For the patients with poor vascular condition in the wrist and forearm,it is not possible to make or reconstruct the ideal internal fistula,and establishment of the upper forearm perforating-vein fistula may obtain satisfying clinical effectiveness.
作者
陆石
王葳
于秀峙
韩国锋
胡伟峰
LU Shi;WANG wei;YU Xiu-zhi;HAN Guo-feng;HU Wei-feng(Department of Nephrology,Naval Specialty Medical Center of PLA,Shanghai 200052,China)
出处
《临床肾脏病杂志》
2019年第10期769-771,共3页
Journal Of Clinical Nephrology
基金
上海市长宁区卫健委“肾脏重点专科”基金(20191005)
南京军区医药卫生科研基金(12MA017)
关键词
血液透析
穿静脉内瘘
血管通路
Hemodialysis
Perforating-vein fistula
Vascular access
作者简介
陆石,男,主任医师,研究方向:血液净化各种治疗模式、各种血管透析通路的建立及其相关并发症的处理,E-mail:shilu_1024@163.com;通信作者:于秀峙,男,副主任医师,研究方向:尿毒症的透析治疗以及血管通路的建立,E-mail:yxz455@163.com。
