介入治疗移植肾动脉狭窄  

Interventional treatment of transplant renal artery stenosis

作　　者：欧阳强[1] 董生[1] 董伟华[1] 肖湘生[1] 常恒[1] 

机构地区：[1]上海第二军医大学附属长征医院影像科,200003

出　　处：《中华放射学杂志》2004年第10期1030-1033,共4页Chinese Journal of Radiology

摘　　要：目的　探讨移植肾动脉狭窄 (TRAS)的介入治疗。方法　 2 1例TRAS患者从肾移植到出现肾动脉狭窄症状平均 6 6个月 (3～ 15个月 ) ,记录经皮血管成形术 (PTA)前后血压变化和肌酐水平。经对侧股动脉或左肱动脉入路 ,使用普通球囊导管 (5F ,直径 4～ 6mm ,长度 2 0～ 30mm)和微球囊导管 (2 6F ,直径 3mm ,长度 36mm)分别对 2 1例TRAS行PTA术 ,其中 5例放置支架。结果 2 1例TRAS患者共行 32次PTA(行 1次PTA 13例 ,2次 5例 ,3次 3例 ) ,其中 2 2次经对侧股动脉 ,10次经左肱动脉穿刺插管。PTA治疗前肾动脉狭窄率为 79%～ 97% ,PTA后狭窄率降为 10 %～ 30 %。PTA前收缩压 15 0～ 2 10mmHg(1mmHg =0 133kPa) ,平均 170mmHg ,舒张压 90～ 14 5mmHg ,平均 12 0mmHg ;PTA后收缩压降为 10 0～ 190mmHg ,平均 135mmHg,舒张压降为 80～ 12 5mmHg,平均 85mmHg。首次PTA后再狭窄率 38% ,再次PTA后狭窄率 14 %。 32次PTA共使用普通球囊导管 2 5个 ,微球囊导管 7个。 5个支架 4个为自膨式支架 ,1个为球囊扩张式。术后随访 3～ 6 0个月 (平均 2 3个月 )。2 1例中最终治愈 6例 ,改善 8例 ,好转 5例 ,无效 2例。除 1例肱动脉入路发生术后穿刺点血肿外无其他并发症。结论　TRAS的PTA治疗安全有效 ,配合肱动脉入路和微球囊导?Objective To analyze the treatment of transplant renal artery stenosis (TRAS) by percutaneous transluminal angioplasty (PTA) and stents. Methods The average time from transplantation to the symptom of TRAS was 6.6 month (3-15 month) in 21 TRAS patients. BP and creatinine level were recorded before and after the procedure. PTA was performed with ordinary balloon (5 F, length 20-30 mm) and/or small balloon (2.6 F, length 36 mm) in all patients, and stents were embedded in 5 of them.Results A total of 32 PTA were successfully performed (1 time, 13 cases; 2 times, 5 cases, and (3 times,) 3 cases) by femoral approach (22) and brachial approach (10). Stenosis were significantly decreased from 79%-97% pre-PTA to 10%-30% post-PTA. Systolic pressure decreased from 170 mmHg (150-210 mmHg) pre-PTA to 135mmHg (100-190 mmHg) post-PTA and diastolic pressure decreased from 120 mmHg (90-145 mmHg) to 85 mmHg (80-125 mmHg). Restenosis rates was 38% after first PTA and 14% after second time. 4 self-expandable stents(Wallstent) and 1 balloon-dilatation stent (Palmaz) were released in 5 cases. There were healing (n=6), melioration (n=8), improvement (n=5), and inefficiency (n=2) after follow-up of 23 months (3-60 month). No complication was found except puncture hematoma by the brachial artery approach in 1 case.Conclusion PTA is safe and effective in the treatment of TRAS and high rates of procedure success may be achieved with the help of brachial approach and small balloon catheter. Reasonable use of stents is beneficial in decreasing the restenosis rates.

关 键 词：球囊导管 入路 移植肾动脉狭窄 肱动脉 介入治疗 股动脉 微球 平均 PTA 记录 

分 类 号：R699.2[医药卫生—泌尿科学]