维持性血液透析患者动静脉内瘘狭窄、闭塞的手术和介入治疗

Clinical Observation of Surgery and Intervention Treatment in Maintenance Hemodialysis Patients with Arteriovenous Fistula Stenosis and Occlusion

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者动静脉内瘘(autogenous arterio-venousfistulas,AVF)狭窄、闭塞手术和介入治疗的效果及可行性。方法对自体AVF狭窄、闭塞的38例MHD患者行手术和介入治疗,多处狭窄者行端端、端侧吻合AVF重建再造术,一处狭窄者采用经皮穿刺腔内血管成形术(PTA),血管条件差、已多次手术者行人造血管移植。结果本组32例行内瘘再造手术,成功率为100%,对患者心功能无影响;2例行PTA治疗,术后即出现明显的血管震颤,可闻及清晰的血管杂音,血流量明显增加,无血管破裂、肺栓塞等并发症;4例行人造血管移植,术后4周开始血液透析,血流量达到300 ml/min以上。结论 AVF重建再造术、PTA、人造血管移植均可有效改善MHD患者AVF狭窄、闭塞后血管通路问题,其中AVF重建再造术最为常用。

Objective To investigate the effect and feasibility of surgery and intervention treatment of arterivenous fistula（AVF） stenosis and occlusion in maintenance hemodialysis（MHD） patients.Methods 38 MHD patients with AVF stenosis and occlusion underwent surgery and intervention treatment.Patients with several stenosis underwent surgery of end to end or end to side anastomosis.Percutaneous transluminal angioplasty（PTA） was performed in patients with only one vessel stenosis.Artificial vessels transplantation were performed in patients with poor vessel condition after multiple AVF surgeries.Results 32 patients underwent AVF reconstruction surgery without effect on cardiac function after treatment,and the successful rate was 100%;2 patients received PTA treatment,with obvious vascular tremor and murmur occurring after treatment,their blood flow improved significantly without complications of vessels rupture and pulmonary embolism.4 patients received artificial vessel transplantation,which provided enough blood flow of more than 300 ml/min in the 4th week after treatment.Conclusion AVF reconstruction surgery,PTA,and vascular prosthesis treatment are effective in MHD patients with arterivenous fistula（AVF） stenosis and occlusion,among which,AVF reconstruction is the most commonly used.