尿毒症患者动静脉内瘘术前超声评估及标记的价值

The Value of Ultrasound Evaluation and Marking before Arteriovenous Internal Fistula in Uremia Patients

目的探讨终末期肾病血液透析患者建立动静脉内瘘术前彩色多普勒超声评估及定位对提高造瘘手术成功率的价值。方法纳入肾脏内科2012年1月-7月尿毒症终末期患者25例，均为多次造瘘失败或为临床建立动静脉造瘘较为困难的患者，术前超声行上肢动静脉及双侧大隐静脉评估，重点观察肱动脉、桡动脉、头静脉、贵要静脉及大隐静脉，寻找肘部及上臂段有无合适搭桥的血管，测量其管径并体表定位。结果14例术前多次造瘘失败患者，9例行再造瘘＋自体大隐静脉移植术，2例行人工血管置人术，1例行左上肢人工血管取栓＋动静脉内瘘成型术，2例放弃手术；11例术前未行动静脉造瘘的患者2例行人工血管置人术，6例行自体大隐静脉移植术，1例因桡动脉管径较细行肱动脉与肘正中静脉高位瘘，2例放弃手术。21例手术患者术后生命指征平稳，瘘口搏动震颤良好。术后～2周内复查彩色多普勒超声示所建通路通畅。结论尿毒症终末期患者动静脉内瘘术前超声评估及定位对提高临床手术成功率有重要价值。

Objective To explore the value of ultrasound evaluation and marking before arteriovenous intemal fistula in end-stage renal disease hemodialysis patients. Methods Twenty-five uremia end-stage patients were admitted into our nephrology department from January 2012 to July 2012. All of the patients had encountered several times of fistula failure or had difficulty in establishing the forearm arteriovenous fistula. We focused on observing the brachial artery, radial artery, cephalic vein, the basilica vein and great saphenous vein. We measured the diameter of the vessels and marked the trend of arteries and veins in the body surface under the ultrasonic navigation. Our goal was to look for appropriate bypass vessels in the elbow and the upper arm. Results Fourteen patients had endured several times of fistula failure. Among the 14 patients, 9 patients completed the surgery of reengineering fistula and autogenous great saphenous vein transplantation, 2 accepted artificial vascular transplantation, 1 completed the removal of blood clots in the left upper limb artificial blood vessels and arteriovenous internal fistula molding, and 2 gave up surgery. Eleven patients could not complete the arteriovenous fistula operation for the fine forearm superficial vein. Of them, 2 patients accepted artificial vascular operation, 6 underwent autogenous great saphenous vein transplantation, 1 with slender radial artery in diameter completed higher position fistula between the brachial artery and median cubital vein, and 2 gave up surgery. Conclusion Arteriovenous internal fistula preoperative ultrasound assessment and marking have very important value in improving the success rate of operation in end-stage uremia patients.