肾移植受者移植术前血液透析用血管通路的建立及术后维护

Preoperative establishment and postoperative maintenance of vascular accesses for hemodialysis in kidney transplantation recipients

绝大多数肾移植受者在接受肾移植前都要接受血液透析治疗。目前常用的血液净化通路有临时透析置管、带隧道带涤纶环透析置管、自体血管的动静脉内瘘(autologous arteriovenous fistula,AVF)和人工血管动静脉内瘘4种。不同的通路类型各有优缺点,临床实际工作中会根据终末期肾病患者的血管条件、病情缓急、预期透析时长等因素进行选择,但针对肾移植等待者尚无明确的血液透析通路选择推荐。本文将对国内外最新研究进展进行综述,对比各类血液透析通路的优劣,结合肾移植等待者的临床特点,为解决肾移植等待者血液透析通路选择及移植术后受者血液透析通路维护2大问题提供参考。

A vast majority of renal transplant recipients receive hemodialysis prior to kidney transplantation(KT).Currently the commonly employed blood purification accesses include non-cuffed catheter(NCC),tunnel-cuffed catheter(TCC),autologous arteriovenous fistula(AVF)and arteriovenous graft(AVG).And the above four accesses types have their inherent advantages and disadvantages.In clinical practices,patients of end-stage renal disease(ESRD)are selected by vascular status,disease severity and expected duration of dialysis.However,no standard recommendation is available for selecting hemodialysis accesses for patients awaiting KT.Summarizing the latest researches in the field,this review compared the advantages and disadvantages of various hemodialytic accesses in conjunctions with the clinical characteristics of patients awaiting KT.The goal was to resolve the choices of selecting and maintaining hemodialysis access for patients awaiting KT.