人工血管移植建立尿毒症患者永久性血管通路的临床应用

Clinical application of permanent vascular access in urinemic patients by artificial vessel graft

目的评价以人工血管移植建立尿毒症患者前臂永久性血管通路的临床应用价值。方法自2008年2月至2012年2月46例尿毒症患者以膨体聚四氟乙烯（e-门FE）人工血管行前臂动静脉内瘘术，并对其术后内瘘的应用情况进行临床分析。结果手术均成功建立内瘘，1例术后2周死于消化道出血，2例内瘘应用1个月后死于心力衰竭，其他43例均获随访3～42个月，能满足每周2～3次的血液透析，临床应用有效率为93．5％。4例应用9～12个月后因内瘘栓塞而改行腹透，5例行2次人工血管内痿术，其中内瘘栓塞3例、锁骨下静脉栓塞1例、假性动脉瘤1例。结论在尿毒症患者前臂浅静脉条件欠佳而难以建立自体动静脉内瘘时，以人工血管移植能有效地建立起满足血透要求的内瘘，是建立永久性血管通路的较好选择。

Objective To evaluate the clinical application of permanent vascular access in urinemic patients by artificial vessel graft in forearm. Methods From February 2008 to February 2012, 46 urinemic patients underwent e-PTFE artificial vessel graft in forearms as a permanent vascular access for hemodialysis. The clinical applications of the accesses were analyzed after operations. Results All the operations could establish the arteriovenous fistulas successfully. One case died of alimentary canal hemorrhage two weeks after the operation, 2 cases died of heart failure one month after the application of artificial vessel fistula. The other 43 cases were followed up for 3 - 42 months. The fistulas could meet the demands of hemodialysis 2 -3 times each week. The effective rate was 93.5% for clinical application. But 9 - 12 months after the application, 4 cases changed to peritoneal dialysis because of the embolisms. Five cases performed the second arteriovenous fistulas, the reasons included embolisms in 3 cases, subclavian vein embolism in 1 case, and false aneurysm in 1 case. Conclusions When the vessels in urinemic patients are too bad to perform arteriovenous fistulas, the artificial vessel grafts can do this effectively for the demands of hemodialysis. It provides a good choice for establishing the permanent vascular access.