儿童“腕部”动静脉内瘘创建的显微外科手术：一项回顾性队列研究
Microsurgery for "wrist" arteriovenous fistula creation in children: a retrospective cohort study.
作者信息
Akturk Afram, Bakx Roel, Oosterveld Michiel J S, Wilde Jim C H, Idu Mirza M
机构信息
1 Department of Vascular Surgery, Emma Children Hospital, Academic Medical Center, Amsterdam - The Netherlands.
2 Department of Paediatric Surgery, Emma Children Hospital, Academic Medical Center, Amsterdam - The Netherlands.
出版信息
J Vasc Access. 2018 Mar;19(2):137-140. doi: 10.5301/jva.5000830. Epub 2018 Feb 19.
INTRODUCTION
Creating functional arteriovenous fistulae (AVF) at the wrist is challenging in paediatric patients because of the small calibre of the blood vessels.
METHODS
We report our experience with AVF surgery in children younger than 15 years of age using microsurgical techniques. Twenty-five patients underwent AVF surgery between 2003 and 2015 (20 for haemodialysis, 4 for plasmapheresis and 1 for parenteral nutrition). Median (range) age was 9 (2-15) years and median weight was 24 (8-61) kg.
RESULTS
The one-month occlusion rate was 8%. The primary and secondary patency rates at 1, 2, 3 years were: 60%, 49%, 42%, and 82%, 72%, 54%, respectively. The median (range) maturation time was 4.53 (0.5-11.2) months. We found no statistically significant effect of patient age, body weight, type of AVF and indication for AVF creation on the primary and secondary patency rates.
CONCLUSIONS
Microsurgical AVF creation at the wrist can be performed with satisfactory results and should be the preferred technique in the paediatric population.
引言
由于小儿血管口径小，在腕部创建功能性动静脉内瘘（AVF）具有挑战性。
方法
我们报告了使用显微外科技术对15岁以下儿童进行AVF手术的经验。2003年至2015年间，25例患者接受了AVF手术（20例用于血液透析，4例用于血浆置换，1例用于肠外营养）。年龄中位数（范围）为9（2 - 15）岁，体重中位数为24（8 - 61）千克。
结果
1个月闭塞率为8%。1年、2年、3年的初次通畅率和二次通畅率分别为：60%、49%、42%，以及82%、72%、54%。成熟时间中位数（范围）为4.53（0.5 - 11.2）个月。我们发现患者年龄、体重、AVF类型以及创建AVF的指征对初次和二次通畅率没有统计学上的显著影响。
结论
在腕部进行显微外科AVF创建可取得满意效果，应成为小儿群体的首选技术。
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