“鼻烟窝”动静脉内瘘用于血液透析的探讨

Study of the effect of internal arteriovenous fistula at anatomical snuff-box for hemodialysis

目的:探索“鼻烟窝”部建立动静脉内瘘的方法及临床应用效果。方法:1998年6月以来,对150例慢性肾功能衰竭者在腕关节以下的解剖“鼻烟窝”部建立动静脉内瘘,采用头静脉与桡动脉的背侧支端侧吻合,4￣6周后用于临床血液透析。结果:150例均为首次内瘘术,术中即刻通畅率100%,5例术后近期内因血管闭塞、2例因透析中血流量不足在对侧施2次手术;132例患者得到术后随访,随访时间1个月￣7年2个月,最多已穿刺880余次,仍使用良好,并发症少。结论:该术式手术操作简便、创面小,扩大了可穿刺范围,吻合成功率高,效果确切,并发症少,可成为长期血透患者的首选血液通路。

Objective：To discuss the establishment of internal arteriovenous fistula at anatomical snuff-box and its clinical application effect.Methods：We have established internal arteriovenous fistula at anatomical snuff-box below the carpal joint for 150 chronic renal failure patients since June,1998, We apply end-to-side anastomosis between cephalic vein and the dorsal branch of arteria radialis for clinical hemodialysis 4-6 weeks later. Results：150 patients were all operated for first time, the instant unobstructed rate during the operation was 100%. 5 patients were operated again on the opposite aide for vascular occlusion, and 2 patients for insufficient blood flow during hemodialysis. 132 patients had the follow-up after operation from 1 month to 7 years and 2 months. The most frequent puncturation had reached 880, and the fistula still worked well with less complications. Conclusion：This type of operation is simple and has tiny raw surface, and it enlarge the puncture range, the anastomosis achievement ratio is high. It has certain effect and less complications, so it can be the first choice of blood passageway for chronic hemodialysis patients.