静脉浅表化术促进自体动静脉内瘘成熟的疗效观察

Observation on the effect of vein superficializing surgery on the promotion of autologous arteriovenous fistula maturation

目的观察静脉浅表化术在促进自体动静脉内瘘的成熟的疗效及安全性。方法选择终末期肾脏病行自体动静脉内瘘术后1~3月,超声测定内瘘静脉前壁与皮肤距离超过6mm的患者11例,行静脉浅表化术。观察术后出血、血肿、感染等并发症情况,术后4周彩超再次检查静脉前壁距皮肤距离、内瘘静脉内径,自然血流量,测量可穿刺长度,并与术前进行比较。内瘘使用后2周行透析充分性评估Kt/V。结果术后无患者出现血肿、出血及感染等并发症,3例患者有短暂的手臂水肿,半月后消失。超声检查术前静脉前壁距皮肤距离6.2~12.5mm,平均(8.87±2.00)mm,术后1月为0.8~1.8mm,平均(1.28±0.33)mm,手术前后比较差异有统计学意义(t=13.616,P<0.001)。术后1月内瘘静脉内径为4.8~7.5mm,平均(5.77±0.76)mm,较术前[4.4~6.8mm,均值(5.55±0.67)mm]有所扩张,差异有统计学意义(t=2.915,P=0.015)。彩超检查自然血流量为(781.00±170.34)ml/min,较术前(681.55±167.93)ml/min增加,差异有统计学意义(t=4.105,P=0.002)。测量可穿刺长度为9~14cm,平均(10.91±1.45)cm。透析充分性评估Kt/V均值为1.59±0.24。截止至2017年2月,11例患者内瘘均未出现过血栓,能够满足每周3次的透析血流量,最长正常使用时间已经超过13个月。结论动静脉内瘘浅表化手术为没有合适浅表静脉的透析患者有效利用自体动静脉内瘘提供了可能性,是一项简单、安全、有效、对手术器械及设备无特殊要求的优选方法。

Objective To observe the effect of vein superficializing surgery on the promotion of autologous arteriovenous fistula maturation. Methods Eleven end-stage renal disease patients who had an autologous arteriovenous fistula surgery 1-3 month ago with a distance of 〉 6mm between the anterior wall of the internal fistula vein and skin by ultrasound were selected for vein superficializing surgery. After the surgery, the possible complications including bleeding, hematoma and infection were monitored. After the surgery for 4 weeks, the distance between anterior wall of the internal fistula vein and skin, diameter of the internal fistula vein, natural blood flow rate, and puncturable length were measured by color ultrasound, and compared with those before the surgery. After use of the internal fistula for blood access for 2 weeks, dialysis adequacy Kt/V was evaluated. Results None of the patients had bleeding, hematoma and infection due to the surgery, and 3 of them had temporal arm edema which disappeared after 2 weeks. After the surgery for one month, the distances between anterior wall of the internal fistula vein and skin reduced from 6.2- 12.5mm （average 8.87± 2.00mm） before the surgery to 0.8- 1.8mm （average 1.28-0.33mm; t=-13.616, P=0.000）; the diameters of the internal fistula vein increased from 4.4-6.8mm （average 5.55-0.67mm） before the surgery to 4.8-7.5mm （average 5.77±0.76mm; t=-2.915, P=-0.015）; the natural blood flow rate increased from 681.55-167.93 ml/min before the surgery to 781.00- 170.34 ml/min （t= 4.105, P=0.002）; the puncturable length was 9- 14cm （average 10.91± 1.45cm）; and the average dialysis adequacy of Kt/V was 1.59-0.24. By Feb. 2017, no thrombosis occurred in the 11 patients, and the internal fistulas were satisfactorily used for blood access 3 times a week with a longest normal usage period of 13 months. Conelusions Superficializing surgery of internal arteriovenous fistula provides a possibility for hemodialysis patients to effectively use autologous arteriovenous fistulas. This is a simple, safe and effective method without requirements of specific instruments and devices.