目的 探讨超声联合血管CT成像 技术(CTA)在尿毒症血液透析患者造瘘术 中的应用价值。方法 选取我院2012年6月 到2016年10月间收治的尿毒症患者55例， 均行血液透析治疗并建立自身头静脉-桡 动脉内瘘。术前、术后均行多普勒超声检 查观察动静脉血管的走行、管腔通畅、血 流充盈等情况，行CTA检查与图像重建观 察内瘘血管流入动脉、流出静脉、吻合 口及狭窄程度等。结果 55例患者均顺利 完成超声与CTA检查，其中12例CTA表现正 常，其余43例均有不同程度动静脉内瘘功 能不全，包括12例单纯流出静脉狭窄、10 例吻合口近端静脉狭窄、7例单纯流入动 脉狭窄、7例吻合口狭窄、6例流入动脉+ 吻合口+流出静脉狭窄及1例窃血。术后 1周、4周动静脉平均内径均明显依次增 加，血流量和血流速度亦依次明显增大， 差异有统计学意义(P＜0.05)。55例患者 术后超声及CTA检查共发现6例(10.91%)并 发症，其中3例内瘘吻合口血栓，2例动 静脉内瘘狭窄，2例动静脉内瘘狭窄伴栓 塞。结论 彩色多普勒超声联合CTA对尿毒 症血液透析患者造瘘术前造瘘血管的选 择、术后血管通路监测、动静脉内瘘成熟 程度评估及并发症诊断有重要的临床应用 价值。

Objective To investigate the application value of ultrasound combined withCT angiography (CTA) in patients with uremia undergoing hemodialysis. Methods Fiftyfive patients with uremia who were admitted to our hospital from June 2012 to October 2016 were selected. All patients were treated with hemodialysis, and the self - cephalic vein - radial artery internal fistula was established. The Doppler ultrasonograph was performed before and after surgery to observe the distribution, patency and blood filling of arteries and veins. CTA scan and image reconstruction were performed to observe internal fistula vascular inflow artery, outflow vein, anastomotic stoma and degree of stenosis. Results All of 55 patients successfully completed ultrasound and CTA examination. The findings of CTA were normal in 12 cases, and the other 43 cases had different degrees of arteriovenous fistula dysfunction, including 12 cases of simple outflow vein stenosis, 10 cases of proximal anastomotic stenosis, 7 cases of simple inflow artery stenosis, 7 cases of anastomotic stenosis, 6 cases of inflow artery, anastomotic and outflow venous stenosis and 1 case of steal.1 week and 4 weeks after operation, the mean diameter of the arteries and veins increased significantly, and the blood flow and blood flow velocity increased significantly (P<0.05). Among 55 cases, there were 6 cases (10.91%) with complications detected by ultrasonography and CTA, including 3 cases of anastomotic stoma thrombosis, 2 cases of arteriovenous fistula stenosis, and 2 cases of arteriovenous fistula stenosis with embolism.Conclusion Color Doppler ultrasound combined with CTA is of great value in selecting vascular fistula before ostomy,monitoring of vascular access after ostomy, evaluating maturity of arteriovenousfistula and diagnosis of complications.