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asbryobvrz · Wysłany: Pon 20:40, 14 Mar 2011

Arteriovenous anastomosis in hemodialysis patients 84 cases of fistula surgery

Surgery, Beijing 100043, China) Key words Hemodialysis; arteriovenous fistula; vascular access in No.】【R459.5 Document code】【B1 objects and methods to be collected in the 2000-01/2006-07 suffering from uremia from long-term hemodialysis patients treated in our hospital 73 (42 males and 31 females), mean age 52 (17-79) years. Among them, 49 cases of chronic nephritis, chronic pyelonephritis in 8 cases, 4 cases of hypertensive renal arteriosclerosis, diabetic nephropathy, 4 cases of other renal diseases in 8 cases. For the establishment of vascular access, are actions vein fistula. Surgical Methods: radial artery and cephalic vein of forearm for anastomosis, anastomotic methods: ① (cephalic vein) end (arterial) side anastomosis: cut off the vein, distal occlusion, proximal vessel clip occlusion, line of hydraulic expansion, the broken veins end of the adventitia stripped clean, and cut into the slope section, so that anastomotic control in 5-6mm, proximal and distal radial artery occlusion in the cycle, then the corresponding radial artery and the vein wall as a 5-6IBm incision, 7 -0 valgus noninvasive continuous nylon suture lines; ② (cephalic vein) end (arterial) end anastomosis: cut off the radial artery,[link widoczny dla zalogowanych], cephalic vein, distal occlusion, proximal vessel clip occlusion, heparin saline flush lumen, intermittent or continuous suture; ③ (cephalic vein) side (arterial) side anastomosis: blocking the artery and vein cycles, respectively, the corresponding wall of artery and vein for the 0.7-1.0IBm diameter of the incision, irrigation lumen, continuous outside turn suture. Vein distal to the silk ligation does not matter, the formation of a constriction ring, diameter 1-2mm; ④ nasopharyngeal fossa anastomosis: nasopharyngeal fossa longitudinal incision 1.5-2.0mm, the first free cephalic vein In the following free artery anastomosis line. 2 Results for 73 patients 84 were performed arteriovenous fistula, surgical assembly power 86%. Flow capacity of 150-250mL/min. Occurred within 24h after heart failure in 6 patients (Table 1). Arteriovenous fistula average 26mo, the longest in patients with 8a, now 2 times a week dialysis, still well used. For various reasons after 10 patients have died due to interruption of renal transplantation in 14 dialysis patients in through the 12 cases,[link widoczny dla zalogowanych], 37 cases lost. Received :2007-07-13; Accepted :2007 -07-19 Author: Zhang Nanfei. Master, the attending physician. Tel: (010) 88689109Email: nan-fei_alan @ hotmail. com3 to discuss the surgical options: direct anastomosis in the forearm arteriovenous fistula surgery ... were established, the cephalic vein end to side anastomosis of the radial artery has more advantages: ① trauma, to maintain the continuity of the artery will not distal limb of the blood circulation; ② distal vein ligation, without arterial pressure, venous pressure is not high hand, almost does not appear swollen hand and hand veins; ③ away from the heart of anastomosis, anastomotic control heart failure in the 5-6lllln smaller rate than the other way; ④ low rate of immediate postoperative thrombosis. Other advantages and disadvantages of 3 surgical methods are as follows: ① end to end: the radial artery was cut, affecting blood circulation distal limbs,[link widoczny dla zalogowanych], heart failure rates are lower than the high end to side anastomosis. ② side to side: low rate of immediate postoperative thrombosis,[link widoczny dla zalogowanych], there will be hand and hand swollen varicose veins, heart failure rate high. ③ snuffbox apparent reason: The operation is complicated, smaller vein,[link widoczny dla zalogowanych], prone to embolization, surgical trauma. Therefore, the need to establish vascular access for hemodialysis patients with chronic renal failure, we preferred end to side anastomosis, poor choice if side to side vascular anastomosis, if the distance option arteriovenous anastomosis. For improved surgical and experience: the size of the decision of anastomotic blood flow in the blood vessels, so in the vein proximal anastomosis technique appropriate section of the hydraulic expansion and blood vessels cut slope, the size of the anastomosis in 5-6mm of the question, to the blood dialysis flow requirements. Open flow of active bleeding after the general need to reinforce 1-2 pin, simply press the bleeding prone to cause thrombosis. In the cephalic vein up the separation process, should be separated in the blood vessels within the vascular sheath, to avoid the superficial branch of radial nerve injuries. Select side to side anastomosis, the vein distal to the silk ligation does not matter, the formation of a constriction ring diameter of 1-2lllln, it can avoid the hand veins, in patients with vascular conditions, if the ligation of arteriovenous difference may be remote, the formation of function on the anastomosis. 【
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