腕部尺动脉-贵要静脉内瘘作为血液透析患者长期血管通路的临床应用价值

Clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis

目的 探讨腕部尺动脉-贵要静脉内瘘作为血液透析患者的长期血管通路的临床应用价值.方法 回顾性分析2013年1月至2014年12月中日友好医院心脏血管外科行腕部尺动脉-贵要静脉内瘘术建立血液透析通路的36例患者的临床资料.术后随访1年,统计分析其手术结果、并发症发生率,以及腕部尺动脉-贵要静脉内瘘的即刻通畅率、平均成熟时间、1年初级通畅率、1年真实通畅率等.结果 共34例患者手术后可及血管震颤,随访期间无死亡病例,无严重心脑血管并发症发生,无感染、肢体肿胀、肢体缺血、心功能衰竭等情况出现.腕部尺动脉-贵要静脉内瘘的即刻通畅率为94.4%（34/36）,平均成熟时间为（67±4） d.1年初级通畅率63.9%（23/36）,1年真实通畅率为67.6%（24/36）.结论 腕部尺动脉-贵要静脉内瘘手术感染率和并发症发生率低,有较好的近期通畅率,可以作为自体血管血液透析通路的选择方案.

Objective To study the clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis.Methods The clinical data of 36 patients with 1-year follow-up who had a wrist ulnar-basilic arteriovenous fistula formed in China-Japan Friendship Hospital from January 2013 and December 2014 were retrospectively analyzed.The outcomes for this study including the surgical results,complication rate of ulnar-basilic arteriovenous fistula,immediate patency rate,average maturation time,1-year primary patency rate and true patency rate were analyzed.Results Thirty-four cases patients got successful ulnar-basilic arteriovenous fistula formed with palpable vascular thrill.There were no death cases and no severe cardio-cerebrovascular complications.No infection,heart failure,distal swelling and ischemia occurred.The immediate patency of ulnar-basilic arteriovenous fistula was 94.4%（34/36）,the average maturation time was （67±4） d,1-year primary patency rate was 63.9%（23/36）,and true patency rate was 67.6%（24/36）.Conclusion Ulnar-basilic arteriovenous fistula with adequate 1-year primary patency and low risk of infection and complications can be a viable alternative as the hemodialysis vascular access.