【摘要】 目的 通过对238例内瘘患者的总结，探讨更好的血透患者的内瘘手术方法及并发症的治疗。 方法 总结我院从1998年至今实行的内瘘手术238例，分别采用钛轮钉和显微外科血管吻合术建立动静脉瘘。手术部位多位于前臂桡侧腕横纹上3～5cm或鼻烟窝处将头静脉与桡动脉作端端或端侧吻合，前臂尺侧腕横纹上贵要静脉与尺动脉端侧吻合。比较各种类型的内瘘的成功率和并发症发生率。 结果 显微外科血管吻合术制作的内瘘成功率高，并发症少，6年的内瘘通畅率达90%以上。 结论 采用动静脉直接吻合制作内瘘是建立血透患者血管通路的良好方法。

    【关键词】 终末期肾病;血液透析;内瘘

    Management of postoperative complication of vascular access for hemodialysis

    LI Hai-chao，WANG Jin，WEI Xiu-ju，et al.

    The Third Hospital of Datong，Datong037008，China

    【Abstract】 Objective To achieve appropriate method for making arteriovenous fistula and treating the access com-plication.Methods We summarized238cases of arteriovenous fistulae performed on end-stage renal disease(ES-RD)patient by direct arteriovenous anastomosis and wheel nail connect.Most of the end(vein)-to-side anastomosis or end-to-end anastomosis were chosen between the radial artery and the cephalic vein on forearm.Occasionally end-to-side anatomosis or end-to-end anastomosis was done between the dorsal artery and the saphenous vein.Results The arteriovenous fistulae could supply enough blood flow and had less complications.Effectiveness of suc-cessful fistulae after6years was up to92%.Conclusion Direct arteriovenous anastomosis to fistulization is the best method for ESRD patient.End-to-side anastomosis should be the first choice because it can supply enough blood flow during hemodialysis and keep free circulation of the blood. ......