动静脉内瘘术后血管畸形的整形修复

Reconstruction of vascular malformations after the internal arteriovenous fistula formation

目的探讨切除血管畸形异常扩张膨大部分,成形剩余血管以修复动静脉内瘘术后血管畸形的临床效果。方法2014年3月至2016年3月,镇江市润州区人民医院整形外科共收治6例腕部端侧吻合人工动静脉内瘘术后血管畸形患者,男4例,女2例,年龄50~68岁,均为造瘘术后1~4年内,2例在前臂近腕关节、4例在前臂近肘关节,局部形成高出皮肤伴血管震颤的血管畸形。术中将皮肤弧形切开、皮下锐性分离,向一侧翻转成舌形皮瓣显露血管畸形异常扩张膨大部分,将其完全游离,以直形肠吻合钳顺血流方向钳夹扩张膨大部分并切除,剩余部分血管成形,对畸形血管进行修复,并观察术后效果。结果本组6例舌形皮瓣均存活,切口一期愈合,术后2 d按原血液透析方案使用成形后的血管通路进行血液透析,保留了动静脉内瘘功能的血液净化通路。结论切除血管畸形异常扩张膨大部分,剩余部分血管成形的手术方法,可以不阻断血流、保留人工动静脉内瘘功能,不影响患者维持血液透析,延长了血管通路的寿命,技术简单可靠。

Objective To investigate the clinical effect of excising the abnormal dilated part of vascular malformation and forming the remaining vessels to repair vascular malformation after arteriovenous internal fistula.Methods From March 2014 to March 2016,six cases with postoperative vascular malformations after the end-side anastomosis of artificial wrist arteriovenous fistula were admitted into the Department of Plastic Surgery in Runzhou District People’s Hospital of Zhenjiang.There were four male cases and two female cases,aged from 50 to 68 years old.All lesions were located on the forearm,with two near the wrist and four near the elbow,forming a local bulgeing vascular malformation with thrill.An arcuate incision was made to form a ligulate flap by sharp subcutaneous dissection,which showed the abnormal expansion of the vascular malformation.The expansion lesion was clamped along with the flow direction by a straight intestinal anastomosis clamp and then resected.Angioplasty was conducted with the remaining portion.Results All flaps in this group survived,and the incision healed in the first stage.Two days after the operation,the blood purification pathway was used for the original hemodialysis protocol with the novel internal arteriovenous fistula,which retained the function of the artificial fistula.Conclusions This simple and reliable technique does not need to block the blood flow and will not affect the patient to maintain the hemodialysis,which prolongs the life of the vascular access.