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自体动静脉内瘘真性动脉瘤的个体化治疗
Individualized Treatment for True Aneurysms of Hemodialysis Access Fistulas
【摘要】 目的总结维持性血液透析自体动静脉内瘘真性动脉瘤的临床特点、手术策略和治疗效果。方法 2009年1月~2017年12月我科对27例自体动静脉内瘘真性动脉瘤根据患者不同情况采用不同的手术方法(局部切除法、间插法、全程置换法、近心端或对侧新建内瘘法、内瘘缝扎法)。结果 5例行动脉瘤局部切除术,4例行动脉瘤切除联合间插人工血管动静脉搭桥术,2例行动脉瘤切除联合全程人工血管置换术,12例行原瘘口封闭联合原瘘近心端动静脉内瘘成形术,2例行原瘘口缝扎联合对侧动静脉内瘘成形术,2例肾移植术后行动脉瘤切除+原瘘口缝扎术。手术成功率100%。术后随访中位时间42个月(2~144个月),术后通畅率80.0%(20/25),动脉瘤无复发。结论自体动静脉内瘘真性动脉瘤是自体瘘术后的晚期并发症,临床表现多样,手术处理方法不同,应根据动脉瘤的特点和患者一般情况采取个体化治疗。
【Abstract】 Objective To summarize the clinical characteristics,operation strategy and treatment effect of true aneurysms of arteriovenous fistula( AVF) in dialysis. Methods The clinical data of 27 patients who underwent operation to treatment true aneurysms of AVF from January 2009 to December 2017 in our hospital were collected. A retrospective analysis about the clinical characteristics,different operative methods( partial resection; graft partly replacement; graft totally replacement; building a new fistula or graft proximally at the same side or the opposite side; aneurysm direct resection) and effect was presented. Results There were 5 cases of partial resection,4 cases of aneurysm resection and graft partly replacement,2 cases of aneurysm resection and graft totally replacement,12 cases of aneurysm resection and building a new fistula or graft proximally at the same side and 2 cases at the opposite side,and 2 cases of aneurysm resection directly after renal transplantation. The surgical success rate was 100%. The postoperative median follow-ups for 42 months( range,2-144 months) in all the patients showed postoperative patency rate being 80. 0%. The aneurysm recurrence rate was 0. Conclusion True aneurysms of AVF is a late complication after fistula surgery with various clinical manifestations. This complication can be treated individually according to aneurysm site and vascular condition of the patient.
- 【文献出处】 中国微创外科杂志 ,Chinese Journal of Minimally Invasive Surgery , 编辑部邮箱 ,2018年08期
- 【分类号】R692.5
- 【被引频次】5
- 【下载频次】220