应用No-touch技术分离静脉构建自体动静脉内瘘对内瘘成熟的影响

Effect of applying no-touch technique for venous dissection on the maturation of autogenous arteriovenous fistula

研究发现,在维持性血液透析患者自体动静脉内瘘(autologous arteriovenous fistula,AVF)构建过程中的静脉分离所造成的血管损伤及其滋养血管损伤对AVF成熟不良的发生起着重要作用,其可通过导致被分离静脉炎症反应、缺氧等影响血管壁细胞增殖、迁移、表型转化及血管壁细胞外基质重构,进而介导AVF的负性血管重构及成熟不良。有研究在利用大隐静脉进行冠状动脉旁路手术时,提出了静脉分离的No-touch技术(no-touch technique,NTT),比较静脉分离的常规技术,NTT能够减轻静脉分离过程所造成的血管损伤及其滋养血管损伤,并提高术后移植静脉的通畅率。近年来,NTT亦开始应用于维持性血液透析患者AVF构建过程中的静脉分离,为促进AVF术后成熟并降低AVF成熟不良发生率提供了新的手术方法。本文将就应用该技术分离静脉构建AVF能够促进AVF术后成熟并降低AVF成熟不良发生率的机制做一综述。

Injuries of vein and its vasa vasorum caused by venous dissection may create autolo-gous arteriovenous fistula(AVF)in patients on maintenance hemodialysis(MHD).Affecting the prolifer-ation,migration,phenotypic transformation of vascular cells and extracellular matrix(ECM)remodeling of vascular wall,inflammatory reaction,hypoxia of dissected vein,negative vascular remodeling and matura-tion obstacle of AVF played some important roles in the occurrence of AVF maturation obstacle.As pro-posed by Souza et al,no-touch technique(NTT)for venous dissection was initially utilized for harvesting great saphenous vein during coronary artery bypass grafting.As compared with conventional techniques(CT)for venous dissection,NTT could alleviate the injuries of vein and its vasa vasorum and boost the postoperative patency rate of venous grafts.In recent years,NTT has also been applied for ve-nous dissection in creating AVF in MHD patients.Thus it offers a novel surgical approach for promoting AVF maturation and lowering the incidence of AVF maturation obstacle.This review focused upon the mechanism of NTT promoting AVF maturation and lowering the incidence of maturation obstacle of AVF.