The increasing number of patients with uremia, the annual increase in the proportion of 5~8% in the new uremia patients need dialysis, and t
The increasing number of patients with uremia, the annual increase in the proportion of 5~8% in the new uremia patients need dialysis, and the younger age. The successful implementation of autologous arteriovenous fistula, as many as possible to make a good fistula and maintain a focus on self fistula. Author experience:
Multi point fistula: body fistula points include: snuffboxes, wrist, elbow fossa, groin, malleolus, supraclavicular and neck, groin, malleolus, supraclavicular and neck for non conventional parts, operation is relatively difficult and application is poor, the best position or snuffboxes, wrist and elbow.
According to the order of stoma fistula: due to the common parts of upper extremities, theory of proximal colostomy, the distal end will not again opportunity fistula, therefore, fistula is the order of the first distal end, and then to the proximal end of the sequential.
The reason of early failure made fistula: stoma fistula is not mature, low flow, error of joints on the side wall, narrow, arterial venous angle, venous thrombosis and distortion; arteries and veins are too thin, small flow; vein proximal stenosis, thrombosis, history of injection and developmental abnormalities. Wait。
Causes of fistula in the late premature failure: application, after the puncture of oppression is not standardized, not standardized (dialysis puncture sites of the same parts of repeated puncture) and fistula of vein stenosis, concentric lumen loss leads to hyperplasia of venous hypertension, leads to severe edema of forearm fistula oppression, etc..
Preoperative routine examination of the vein of the fistula, usually with a history of injection.
For men, more than 165cm, laborers, less than 55 years of age without diabetes, as the first choice of snuff bottles, which can increase a fistula opportunity; of course, for the relatively stout young woman laborer snuff bottle is also preferred; because the artery in patients with diabetes and vascular lumen narrow city women slim in this part, it is difficult to succeed.
Try to use the venous end artery end to side side anastomosis, so the ostomy side hand blood circulation influence, try to avoid the wrist and the snuff box parts of the side to side anastomosis to avoid severe limb venous hypertension.
During the operation, if the fistula was found to be successful, the venous tremor was not obvious. It was suggested to open the fistula or choose a branch of the vein to guide the exploration of the stenosis or occlusion of the vein.
Try to use the expansion of vein anastomosis, trim for "Cobra head", "artery trim for long fusiform, so large and relatively large anastomotic flow; such as poor heart function, arterial venous bulky, appropriately control the size of fistula, avoid excessive flow induced heart failure.
The use of parachute continuous suture, can reduce the difficulty of operation, increase the accuracy of stitching.