摘要
目的探讨胸壁人工血管透析通路（arteriovenous axillary loop graft,AVALG）作为慢性肾衰竭患者血液透析通路的中期疗效。方法回顾性分析2010年12月-2014年5月,因多次自体动静脉内瘘成形术（arteriovenous fistula,AVF）和人工血管动静脉内瘘（arteriovenous graft,AVG）闭塞后上肢血管通路耗竭而建立AVALG的12例慢性肾衰竭患者临床资料。其中男2例,女10例;年龄46～75岁,平均65.25岁。慢性肾衰竭的基础疾病为慢性肾小球肾炎6例,糖尿病肾病4例,泌尿系肿瘤双肾切除术后2例;病程2～12年,平均6年。患者均接受5～14次,平均7次AVF和AVG后,透析通路闭塞造成上肢血管通路耗竭。结果术后首次透析时间42～93 d,平均48 d;每周2～3次,透析时血流量250～350 m L/min。12例均获随访,随访时间12～54个月,平均20.92个月。术后6、12个月初级通畅率分别是91.7%和83.3%,次级通畅率均为100%。术后发生穿刺部位感染1例,血栓形成2例,肢体持续肿胀1例,出血2例,均经相应处理后治愈。结论慢性肾衰竭患者上肢透析通路反复闭塞、血管耗竭,无合适血管通路时可选择AVALG。
Objective To explore the role of arteriovenous axillary loop graft（AVALG） on chest for establishing hemodialysis access in patients with chronic renal failure. Methods A retrospective analysis was made on the clinical data of 12 patients with chronic renal failure who underwent an AVALG on chest for hemodialysis access between December 2010 and May 2014. There were 2 males and 10 females with an average age of 65.25 years（range, 46-75 years）. The main causes were chronic glomerulonephritis in 6 cases, diabetic nephropathy in 4 cases, and both kidney resection because of urinary tract tumors in 2 cases. The disease duration was 2-12 years（mean, 6 years）. The 12 patients all underwent 5-14 times（mean, 7 times） failed prior vascular accesses [arteriovenous fistula（AVF）and arteriovenous graft（AVG）] leading to exhaustion of venous access sites on the upper extremities. Results The AVALG on chest were functionally useful for hemodialysis access, 2-3 times per week, and the blood flow was 250-350 m L/minute; the average time for the first dialysis was 48 days（range, 42-93 days）. All patients were followed up 12-54 months（mean, 20.92 months）. There was no death during perioperative period. The primary patency rates at 6 and 12 months were 91.7% and 83.3% respectively, and the secondary patency rates at 6 and 12 months were both 100%. After operation, infection（1 case）, thrombosis（2 cases）, bleeding（2 cases）, and swollen（1 case） occurred, which were all cured after corresponding treatment. Conclusion AVALG on chest is a supplementary option for chronic renal failure patients with inadequate upper extremity venous access sites after repeat occlusion.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第9期1129-1132,共4页
Chinese Journal of Reparative and Reconstructive Surgery
