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目的观察糖尿病肾病CKD5期内瘘成形术患者桡动脉、头静脉血管的病理变化。方法选择64例糖尿病肾病CKD5期患者非优势手行桡动脉-头静脉吻合术,术中留取吻合处血管进行病理学送检(实验组);另外选择26例年龄相仿的上肢截肢患者,手腕部相当于内瘘位置,取动、静脉血管进行病理学送检(对照组)。结果 HE染色结果显示64例糖尿病肾病CKD5期患者,其中桡动脉2例炎细胞浸润、粘液样变性,12例纤维组织增生,28例内膜分层、增厚、硬化,11例粥样斑块形成;头静脉3例炎细胞浸润、粘液样变性,5例纤维组织增生,12例内膜增厚、分层,5例钙化灶形成。实验组桡动脉38例(59.4%)及头静脉25例(39.1%)有不同程度病理学变化。对照组仅有2例(7.69%)表现为纤维组织增生,差异有显著性(P<0.05)。结论糖尿病肾病CKD5期患者血管均有不同程度的病理学变化,故提早行内瘘手术及选择合适的吻合方式是内瘘成功的关键。
Objective To observe the pathological changes of radial artery and cephalic vein in CKD stage 5 diabetic nephropathy patients. Methods Sixty-four patients with diabetic nephropathy were enrolled in this study. Non-dominant hand radial artery-head vein anastomosis was performed in 64 patients with diabetic nephropathy. The anastomosis blood vessels were taken for histopathological examination in the experimental group (experimental group). In addition, 26 age-matched upper limb amputation patients Department of internal fistula is equivalent to the location, take, venous pathological examination (control group). Results The results of HE staining showed that in 64 CKD patients with diabetic nephropathy, there were 2 inflammatory cell infiltrates, 2 myeloid degeneration, 12 fibrosis, 28 intimal hyperplasia, thickening and sclerosis, and 11 atherosclerotic plaques 3 cases of inflammatory cell infiltration, myxoid degeneration, 5 cases of fibrous tissue hyperplasia, 12 cases of intimal thickening, stratification, 5 cases of calcification. In the experimental group, 38 cases (59.4%) of radial artery and 25 cases (39.1%) of head vein had pathological changes of varying degrees. Only two cases (7.69%) in the control group showed fibrosis, the difference was significant (P <0.05). Conclusion The blood vessels of CKD stage 5 diabetic patients all have different degrees of pathological changes. Therefore, it is the key to the success of internal fistula to choose the suitable anastomosis for early fistula operation.