桡侧返动脉内瘘术在老年患者中的临床应用

Clinical application of radial recurrent artery fistulas in the senile patients

目的探讨桡侧返动脉内瘘的手术方法及临床效果。方法回顾性分析解放军第四五一医院血液净化中心行桡侧返动脉内瘘术的治疗效果,通畅率及并发症。结果自2007年8月至2013年10月利用桡侧返动脉与肘正中静脉、头静脉建立内瘘病例共66例,男性35例,女性31例,平均年龄(71±7.8)岁,全部病例手术成功,无感染、血肿及心力衰竭等并发症,无围手术期死亡,术后1～2月开始穿刺行血液透析。术后1年、2年通畅率分别为91.1%及87.5%。无明显心力衰竭及窃血综合征发生。结论桡侧返动脉内瘘具有手术创伤小,血液透析径路长,手术成功率、通畅率高,可以代替肘窝高位动静脉内瘘作为血管通路手术的第2选择。

Objectives To summarize our experience about the operation method for radial recurrent artery fistulas（RRAFs）and its clinical effects in the senile patient. Methods We retrospectively analyzed the maturation,patency and complications of the RRAFs performed between August 2007 and October 2013 in our center.Results A total of 66 cases（35 males and 31 females;mean age 71±7.8 yrs）were treated with the radial recurrent artery and intermedian cubital vein（or its cephalic vein） .RRAFs were successfully established in all patients without complications including hemotoma,wound infection,high output cardiac failure and perioperative mortality. The RRAFs were functionally useful for hemodialysis access after the operation for 1-2 months. After the operation for one and two years ,the patent rate was 91.1% and 87.5%,respectively.Conclu- sion RRAFs is a new method better than the brachial artery in-flow AVF.This method has the advantage of less injury, heart failure,steal blood syndrome and arm edema,a longer and straight conduit for vascular access, and a high patency rate.