支架成形术治疗肾动脉狭窄  

Renal artery stent angioplasty for renovascular hypertension

作　　者：李刚[1] 李海青[1] 王琳[1] 

机构地区：[1]山东省泰安市泰山医学院第一教学医院普外科,271000

出　　处：《介入放射学杂志》2005年第1期48-50,共3页Journal of Interventional Radiology

摘　　要：目的　分析支架成形术治疗肾动脉狭窄临床疗效。方法　本组肾血管性高血压患者 15例 ,肾动脉狭窄病变血管 15支 (13例 ,89% ) ,闭塞病变血管 2支 (11% )并肾功能衰竭。其中 ,双侧肾动脉受累 2例。狭窄病例中 ,治疗前狭窄程度为 6 0 %～ 90 %。共植入支架 16枚。术后观察患者状况及血管造影随访结果。结果　技术成功率 10 0 % ,未发生严重并发症。随访 6～ 15个月 ,显示临床治愈 4例(2 6 % ) ,改善 9例 (6 0 % ) ,无效 2例 (13% ) ,临床总有效率 86 %。收缩压由术前平均 (2 7.12± 3.0 9)kPa降至术后随访平均 (18.6 2± 3.12 )kPa ,舒张压由术前平均 (17.73± 1.92 )kPa降为术后平均 (11.12± 2 .4 3)kPa(P <0 .0 5 )。术后肾功能保持稳定者 9例 (6 0 % ) ,明显好转者 5例 (33% ) ,继续恶化者 1例 (6 % )。造影复查 1例 (6 .7% ) ,于术后 6个月出现支架内再狭窄 (约狭窄 70 % ) ,经支架内球囊扩张后 ,随访 2次血管造影其再狭窄程度稳定在 2 0 %左右。结论　内支架成形术治疗肾动脉狭窄 ,临床疗效显著 ;闭塞病例支架成形治疗的成功 。Objective To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods 15 patients (10 men and 5 women, 41～75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent agioplasty including renal arterial stenosis 89% (n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of flouroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinial and angiographic follow up. Results Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up(6-15 months:mean, 8±4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12±3.09 kPa to 18.62±3.12 kPa and the average diastolic blood pressure decreased from 17.73±1.92 kPa to 11.12±2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60%(n=9) patients with improvement in 33%(n=5) and worsened in 6%(n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions Percutaneous transluminal stent placement is highly benefitial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals a wide prospects for interventional method.

关 键 词：治疗 肾动脉狭窄 支架成形术 术后 血管造影 术前 患者 随访 闭塞 临床疗效 

分 类 号：R692[医药卫生—泌尿科学]