用常规方法吻合血管壁硬化的小血管具有较大难度,我们将钛轮钉吻合血管的方法加以改进,用以吻合血管壁明显硬化的血管作血透用动静脉内瘘,1995年6月～1996年8月共完成8例均获成功,现报告如下。 临床资料 本组8例慢性尿毒症患者均为男性,年龄60～69岁(平均63.5岁),其中慢性肾炎3例、糖尿病肾病2例、双侧尿路结石梗阻2例、直肠癌术后盆腔转移性癌肿压迫双侧输尿管1例;其中合并高血压6例,高血脂4例。8例均作桡动脉和临近浅静脉端端吻合。 手术方法 (1)常规确定切口位置,在局麻下切开皮肤及皮下筋膜,先后游离待吻合的浅静脉和桡动脉各1.5cm左右,分别结扎并离断动静脉远心端,剪除部分血管外膜。(2)用微血管钳轻轻伸入血管腔进行扩张,并探测管腔大小及管壁弹性。(3)将硬化的动脉断端沿轴线作“+”形剪开约2mm,使成均匀的4瓣,将各瓣翻转分别悬挂轮钉的4个脚上,静脉用常规方法悬 A conventional method to match the vessel wall sclerosis of the smaller blood vessels more difficult, we will titanium nail staple anastomosis of blood vessels to be improved, in order to match the vascular wall was significantly hardened blood for hemodialysis arteriovenous fistula, June 1995 ~ August 1996 completed a total of 8 cases were successful, are as follows. Clinical data of 8 patients with chronic uremia in this group were male, aged 60 to 69 years (mean 63.5 years), of which 3 cases of chronic nephritis, diabetic nephropathy in 2 cases, bilateral urinary tract obstruction in 2 cases, postoperative pelvic Metastatic cancer oppression of bilateral ureter in 1 case; of which 6 cases of hypertension, hyperlipidemia in 4 cases. 8 cases were made radial artery and proximal superficial vein anastomosis. Surgical methods (1) to determine the location of incision routinely under local anesthesia incision skin and subcutaneous fascia, has to be free to be consistent with the superficial and radial artery of about 1.5cm, were ligated and separated from the telecentric telecentric, cut off part Vascular adventitia. (2) gently microvascular forceps into the vessel lumen to expand, and detect the lumen size and wall flexibility. (3) The hardened arterial stump along the axis for the “+” shape cut about 2mm, into a uniform 4, the flap flipped over the four legs were spooled, the vein suspended by conventional methods