腕部头静脉的解剖研究在动静脉内瘘成形术中的应用

Application of the Cephalic Vein Anatomy of the Wrist in Arteriovenous Fistula Angioplasty

目的:探讨上肢腕部头静脉解剖学特点在动静脉内瘘成形术中的应用。方法:选择30例慢性肾衰竭5期患者,术前彩超辅助下标记头静脉主干,以腕部头静脉手背支和头静脉拇指支汇合点为中心,将腕部头静脉分成腕部远心端头静脉段和腕部近心端头静脉段,测量各段静脉直径、静脉分支及瓣膜的数量、各段头静脉与桡动脉间距等指标,并通过术中观察再次确认静脉的瓣膜及分支。结果:腕部远心端段头静脉直径明显小于腕部近心端段头静脉直径,两者相比较差异存在统计学意义(P<0.01),腕部近心端段的头静脉瓣膜及静脉分支较远心端段少,两者相比较差异也存在统计学意义(P<0.01),且腕部近心端段的头静脉与桡动脉间距离较腕部远心端头静脉近(P<0.05)。结论:上肢腕部远心端头静脉偏细小,且存在较多的分支及瓣膜,而腕部近心端头静脉有更大的直径以及较少的分支和瓣膜,更符合临床动静脉内瘘成形术的要求。

Objective：To investigate the anatomic characteristics of upper limb wrist cephalic vein in arteriovenous fistula angioplasty and stenting in. Methods：30 cases of chronic renal insufficiency in 5 patients,preoperative color Doppler ultrasound as-sisted subscript head vein,cephalic vein to the wrist dorsal branch and the head vein thumb confluence point as the center,will head into the wrist wrist vein distal of cephalic vein segment and wrist proximal head vein segment,measuring sections vein diameter, branch vein and valve number,each section of the cephalic vein and radial artery spacing index,and once again confirmed as a branch and venous valve by intraoperative observation. Results：The wrist distal segment of the cephalic vein diameter was significantly smaller than the wrist proximal segment of the cephalic vein diameter,the comparison was significantly statistical difference（P ﹤0. 01）,head of venous and venous branch proximal segment of the wrist is distal segment is little,the comparison is also very signifi-cant statistical difference（P ﹤ 0. 01）,and the wrist proximal segment of the cephalic vein and radial artery in the wrist between the distance distal cephalic vein near（P ﹤ 0. 05）. Conclusion：Upper limb wrist distal cephalic vein partial small,and there are many branches and valves,and wrist proximal vein head has a greater diameter and fewer branches and valve,more in line with the clinical arteriovenous fistula angioplasty requirements.