摘要
目的探讨近心端重建动静脉内瘘成形术与吻合口原位取栓再次成形术2种手术方式在处理血液透析患者动静脉内瘘血栓形成的手术疗效。方法选取云南省曲靖市第一人民医院泌尿外科2009年9月至2014年7月102例动静脉内瘘血栓形成患者,男64例,平均年龄(44.3±2.7)岁;女38例,平均年龄(45.2±1.9)岁。102例患者中采用近心端重建动静脉内瘘成形术60例,其中男38例,女22例,平均年龄(46.1±2.4)岁,内瘘使用时间平均为(16.3±3.1)个月,血栓形成时间平均为(72.5±0.4)h。42例患者采用吻合口原位取栓再次成形术,其中男26例,女16例,平均年龄(47.5±3.2)岁,内瘘使用时间平均为(16.9±2.9)个月,血栓形成时间平均为(72.1±0.3)h。比较两种术式的手术成功率,术后1年内吻合口狭窄的发生率及血栓再次形成的发生率。结果近心端重建动静脉内瘘成形术手术成功57例,成功率95%;术后1年吻合口狭窄5例,狭窄发生率8.8%;血栓再次形成4例,发生率7.0%。吻合口原位取栓再次成形术手术成功26例,成功率61.9%;术后1年吻合口狭窄9例,狭窄发生率35.4%;血栓再次形成5例,发生率19.2%。结论与原位取栓再次成形术相比,近心端重建动静脉内瘘成形术在处理血液透析患者动静脉内瘘血栓形成时能明显降低术后吻合口狭窄和血栓发生的几率,疗效显著,可作为首选。
Objective To investigate the surgical effect of two methods： proximal reconstruction dynamic venous fistula angioplasty and anastomotic orthotopic thrombectomy re-angioplasty in treating patients with thrombosis of arteriovenous fistula in hemodialysis patients. Methods We selected 102 patients with venous fistulas thrombosis in our hospital from September 2009 to July 2014. There were 64 males,with an average age of（ 44. 3 ± 2. 7） years,and 38 females,with an average age of（ 45. 2 ± 1. 9） years. In 102 patients,60 cases were treated with proximal reconstruction of arteriovenous fistula,of which 38 were male and22 were female,with an average age of（ 46. 1 ± 2. 4） years old. The average time of internal fistula was（ 16. 3 ± 3. 1） months,and the average time of thrombosis was（ 72. 5 ± 0. 4） h. Forty-two cases were treated by thrombectomy in situ anastomosis re-angioplasty. There were 26 males and 16 females. The average age was（ 47. 5 ± 3. 2） years old,the average time of fistula was（ 16. 9 ± 2. 9） months,and average thrombosis time was（ 72. 1 ± 0. 3） h. The success rate,anastomotic incidence of stenosis within 1 year after operation and recurrent rate of thrombosis were compared between two surgical operations. Results Of 60 cases subject to proximal reconstruction of arteriovenous fistula,the surgical success rate was 95. 0%,anastomotic stenosis occurred in 5 cases（ 8. 8%） after 1 year,and thrombosis recurred in 4 cases（ 7%）. Twenty cases were successfully treated with embolectomy at the anastomotic site with a success rate of 61. 9%. Anastomotic stricture occurred in 9 cases（ 35. 4%） after 1 year,and thrombosis reoccurred in 5 cases（ 19. 2%）（ P〈0. 01）. Conclusions In comparison to in situ thrombectomy re-angioplasty,the proximal reconstruction of arteriovenous fistula angioplasty in the treatment of thrombosis of iliac artery fistula in hemodialysis patients can obviously reduce the incidence of stenosis and thrombosis of the postoperative anastomot
出处
《临床肾脏病杂志》
2017年第10期606-609,共4页
Journal Of Clinical Nephrology
关键词
血液透析滤过
动静脉内瘘
血栓
手术
Hemodialysis filtration
Arteriovenous fistula
Thrombus
Operation
