【摘要】目的探索一种简单有效的对高流量自体动静脉内瘘进行限流的手术方式。方法回顾性分析厦门大学附属第一医院肾内科2016 年1 月～2020 年12 月对高流量自体动静脉内瘘在超声引导下使用改良MILLER 手术进行动脉限流患者共12 例，手术前内瘘均进行彩超检查，手术中使用泰尔茂6F 血管鞘芯置于距瘘口2cm 的近端动脉表面，用7 号丝线套圈2 处，并于手术中实时彩超监测，通过调节丝线套圈的松紧度使肱动脉流量在800～1000ml/min，于手术当天、手术后3 个月及手术后6 个月复查内瘘彩超。结果① 手术后套圈处动脉的平均直径较手术前缩小[(3.32 ± 0.28) 比(4.85 ± 0.35)mm，t=20.282，P=0.001]，手术后套圈处动脉直径分别与手术后3 个月(t=-1.295，P=0.209)及手术后6 个月(t=-1.342，P=0.193)比较差异均无统计学意义。②手术后肱动脉流量较手术前下降，[(913±33)比(1905±243)ml/min, t=13.923, P=0.001]，手术后3 个月(t=-0.364, P=0.719)及手术后6 个月(t=-0.806, P= 0.429)复查肱动脉流量与手术后比较差异无统计学意义。结论超声引导下改良MILLER 手术在超声引导下套圈精确,可以对高流量动静脉内瘘进行有效限流,手术后内瘘血流量稳定，术式简单易做，安全有效，花费低，值得推广。
【Abstract】Objective To explore a simple and effective operation to limit the flow of high-flow autogenous arteriovenous fistula (AVF). Methods A total of 12 patients with high-flow AVF treated in the Department of Nephrology, the First Affiliated Hospital of Xiamen University from January 2016 to December 2020 using modified MILLER surgery under ultrasound guidance to limit arterial flow were retrospectively analyzed. These AVFs underwent color Doppler ultrasound examination before operation. During the operation, the core of Terumo 6F vascular sheath was placed on the surface of the proximal artery 2 cm away from the fistula, and the sheath core was looped with a slipknot using a 7-gauge silk thread; there were two ferrules with an average interval of 1cm; color Doppler ultrasound monitors the artery diameter and brachial artery flow at the ferrule, and the tightness of the silk loop was adjusted to make the brachial artery flow within 800-1000 ml/min. Color Doppler ultrasound examination for the AVF was repeated on the day after operation, 3 months after the operation, and half a year after the operation. Results The average diameter of the artery after the operation was significantly reduced compared with that before the operation (t=20.282, P=0.001). The artery diameter at the ferrule was rEexamined after the operation for 3 months and half a year, and the two values had no statistical significance (t=-1.295, -1.342; P=0.209,0.193). The blood flow in the brachial artery after the operation was significantly lower than that before the operation (t=13.923, P=0.001). The postoperative blood flow in the brachial artery was rEexamined after the operation for 3 months and half a year, and the two values had no statistical significance (t=-0.364,-0.806; P=0.719,0.429). Conclusion The modified MILLER operation under ultrasound guidance can accurately adjust the ferrules to effectively limit the flow in highflow AVF. The postoperative blood flow in the AVF was stable. This surgical method is simple, easy to perform, safe, effective, low cost, and worthy of promotion.
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