细小血管动静脉内瘘成形术技巧及术前术后观察

Technique of arteriovenous fistula operation of thin blood vessel and observation before and after operation

目的 总结25例术前头静脉血管直径〈2.0 mm的自体动静脉内瘘手术成功经验,为预测动静脉内瘘成功与否的术前头静脉内径提供新的参考范围.方法 前瞻性对慢性肾脏病5期患者行动静脉内瘘成形术,术前进行血管超声检查,测量桡动脉及头静脉直径、桡动脉平均流速,术后1个月重复测量头静脉及桡动脉直径,以及内瘘血流量,平均流速等,依据术前头静脉血管直径,将患者分为观察组和对照组.头静脉血管直径〈2.0 mm为观察组,〉2.0 mm的为对照组.记录术后首次使用时间（记为成熟期）及透析后1个月透析时血流量,观察组及对照组例数均为25例.以术前血管直径、成熟期,透析后1个月透析血流量进行对比,评价内瘘功能及成功率.结果 观察组25例患者有1例术后未闻及血管杂音,定义为原发性手术失败;1例因动脉过于细小,虽手术成功,但术后3个月仍不能达到透析需要的血流量,并最终死于心脏并发症而结束观察,其余内瘘均成功并用于透析治疗,术后成熟期为（47.29 ± 2.45）d,与对照组（36.00 ± 1.29）d相比明显延后,P〈0.01;透析后1个月血流量与对照组比较差异无统计学意义（P〉0.05）.结论术前头静脉血管直径〈2.0 mm的患者行动静脉内瘘成形术需要较长的成熟期,但基本不影响透析后的血流量,也取得良好的成功率.

Objective To study the success experience of native arteriovenous fistula （AVF） operation,and provide a new reference range of blood vessel diameter for evaluating the success rate of AVF operation before surgery.Methods To proceed AVF operation to patients with 5 phase of chronic kidney disease,before surgery,patients should receive the vascular ultrasound and cardiac ultrasound to record the diameter of radio artery and cephalic vein along with the radio artery blood flow.Patients were divided into two groups：observation group（cephalic vein diameter〈 2 mm）and control group（cephalic vein diameter 〉 2.0 mm）. All those indexes examined before were re-examined 1 month after surgery. Except vessel diameter, the AVF blood flow velocity was also recorded. The range of the mature period was measured, along with the blood flow of each AVF 1 month after its initial use. The blood vessel diameter before surgery,the mature period of AVF and the blood flow on the machine of dialysis 1 month after the initial use were measured to evaluate the operation results of each group. Results In the observation group, 23 of the 25 patients showed the optimistic results. Unfortunately, 1 of the 2 pessimistic results showed the absence of vascular murmur,and the other one died of natural death before its initial use.The mature period of AVF for hemodialysis was（47.29 ± 2.45）d,significantly longer than that of control group （36.00 ± 1.29） d, and there was statistical difference （P〈0.01）. The blood flow of observation group showed no significant difference compared to that of control group （P 〉 0.05）. Conclusions The patients with cephalic vein diameter〈2.0 mm before operation needs a long mature period,but the blood flow after dialysis is not affected,and a good success rate is obtained.