血液透析通路并发症的外科处理

Surgical Treatment for Complications of Hemodialysis Access

目的总结血液透析通路并发症的外科处理经验,提高治疗水平。方法回顾分析我院尿毒症血透通路并发症外科处理的患者临床资料。结果直接穿刺造成假性动脉瘤、动静脉的瘘手术修补6例,1例大隐静脉移植重建股动脉,均治愈。CVC狭窄2例,球囊扩张中心静脉,更换CVC,随访至今,通路通畅。AVF狭窄予手术共再做AVF 5例,平均随访15月,4例闭塞,其中1例再狭窄予球囊扩张,另1例对侧前臂AVF。AVF狭窄介入手术的共20例患者,技术成功18例,2例发生内瘘血管扩张后破裂、1例血栓形成,转手术。平均随访(5.6±3.0)月,再狭窄3例,2例予再次介入球囊扩张,1例术后3月死于高钾血症。结论对于不同并发症采用个体化的治疗方案,目前介入下血管成形治疗内瘘血管狭窄有微创优势,但是远期均存在较高再狭窄率。

Objective Summarize the surgical treatment experience of hemodialysis access complications and improve the treatment level.Methods The medical records and follow-up data of surgical treatment of hemodialysis patients with hemodialysis access complications due to uremia were retrospectively analyzed from April 2014 to January 2019.Results Direct puncture caused pseudoaneurysms and arteriovenous fistulas in 6 cases,and 1 case of great saphenous vein transplantation to reconstruct the femoral artery,all cured.In 2 cases of CVC stenosis,the central vein was expanded by the balloon and the CVC was replaced.Since follow-up,the access is unobstructed.A total of 5 cases of AVF stenosis were operated on for new AVF.The average follow-up was 15 months.4 cases were occluded.Among them,1 case of restenosis was balloon dilated,and the other case had AVF on the contralateral forearm.A total of 20 patients underwent AVF stenosis interventional surgery,18 of them were technically successful,2 had internal fistula vasodilation and then ruptured,1 had thrombosis,and were transferred to surgery.The average follow-up was(5.6±3.0)months,3 cases were restenosis,2 cases were re-interventional balloon dilatation,1 case died of hyperkalemia 3 months after operation.Conclusions For different complications,individualized treatment is adopted.At present,interventional angioplasty has the advantage with minimally invasive treatment,but in the long run,there is a high rate of restenosis.