【摘要】 目的探讨自体大隐静脉移植重建上肢血液透析通路的临床应用效果。方法回顾性分析2015年7月至2018年12月采用自体大隐静脉移植重建上肢血液透析通路的47例患者的临床资料,均为前臂血管耗竭。采用前臂"U"型或桡侧直行皮下隧道,于下肢取适当长度大隐静脉行预扩张,两端修剪成斜面,远心端与腕部桡动脉或肘部肱动脉行端侧吻合,近心端与上臂头静脉或贵要静脉或正中静脉行端端吻合,完成血透通路。结果本组手术血管吻合均获成功,血管震颤明显,无围手术期死亡。术后随访3～24个月,1例于术后1年死于心力衰竭,1例术后2年死于消化道出血,失访7例。术后3、 6、 12、 18和24个月移植血管通畅率分别为97.87%、 93.62%、 80.85%、 76.09%和71.79%。结论自体大隐静脉移植重建上肢血液透析通路,手术简单,术后并发症少,使用方便,通畅率高,为上肢血管耗竭的患者提供了理想的解决方案,值得深入研究和推广。更多还原

【Abstract】 Objective To evaluate the clinical effect of autologous great saphenous vein transplantation for the reconstruction of upper limb hemodialysis access. Methods A retrospective analysis was performed on the clinical data of 47 patients with forearm vascular depletion reconstructed upper limb hemodialysis access by autologous great saphenous vein transplantation from July 2015 to December 2018. A "U" or radial straight subcutaneous tunnel was used in the forearm, an appropriate length of great saphenous vein was harvested to pre-expand in the lower limbs. Both ends were trimmed to bevels. The distal end of the great saphenous vein was anastomosed end-to-side with the radial artery of wrist or brachial artery of the elbow, and the proximal end of the great saphenous vein was anastomosed end-to-end with the cephalic vein, the basilic vein or the median vein of the upper arm to complete the hemodialysis pathway. Results The vascular anastomosis was successful in all cases with obvious vascular tremor. No perioperative death occurred. There was one patient died of heart failure one year and another one died of gastrointestinal bleeding two years after the surgery during 3 to 24 months follow-up, and 7 patients were lost to follow-up. The unobstructed rate of planted blood vessels at 3-, 6-, 12-, 18-and 24 months was 97.87%, 93.62%, 80.85%, 76.09% and 71.79%, respectively.Conclusions Autologous great saphenous vein transplantation is easy to reconstruct the upper limb hemodialysis access with less postoperative complications,convenient application and high patency rate. It provides an ideal solution for the patients with upper limb vascular depletion,and is worthy of further research and promotion.更多还原