经皮血管成形术治疗肾动脉纤维肌性发育不良的临床结果  

Clinical Outcomes of Percutaneous Transluminal Angioplasty as Treatment for Renal Artery Fibromuscular Dysplasia

作　　者：蒋雄京[1] 吴艳[1] 杨倩[1] 吉薇[1] 吴海英[1] 张慧敏[1] 腾思勇[1] 郑德裕[1] 惠汝太 刘力生[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院高血压诊治中心,北京100037

出　　处：《中华高血压杂志》2010年第7期643-647,共5页Chinese Journal of Hypertension

摘　　要：目的评价经皮血管成形术(PTA)治疗肾动脉纤维肌性发育不良(FMD)的安全性及疗效。方法我院近6年来连续26例,均因严重高血压,经实验室检查、临床资料分析和动脉造影确诊为肾动脉FMD的住院患者,并进行了球囊扩张或选择性支架术。回顾性分析其临床特点、手术安全性并随访疗效。结果 26例患者年龄13～47(25.6±5.5)岁,其中女性15例(57.7%)。共32条肾动脉受累,其中30条肾动脉直径狭窄≥60%,行PTA,包括单纯球囊扩张16例(61.5%),球囊扩张加切割球囊4例(15.4%),球囊扩张加支架置入6例(23.1%),技术成功率为96.2%(25/26),未发生操作相关的严重并发症。术后随访12～72月,血压及降压药种数较术前显著下降(P<0.01);在第1～6年时被治疗肾动脉原发再狭窄率分别是:17.4.0%,20.0%,25.0%,33.3%,33.3%,33.3%,且再次PTA治疗均有效。结论 PTA治疗肾动脉FMD安全,中远期疗效好。Objective To evaluate the safety and efficiency of percutaneous transluminal angioplasty (PTA) as treatment for symptomatic renal artery fibromuscular dysplasia (FMD). Methods Twenty-six continuous in-patients with FMD in the past 6 years who underwent PTA for severe hypertension were enrolled in the retrospective study. Blood pressure,use of antihypertensive medications,renal function and cardiovascular events were followed up. Results In 26 patients,aged 13-47(25.6±5.5) years,female 15(57.5%),32 renal arteries were involved angiographically. Thirty of 32 lesions with diameter reduction ≥60% were performed PTA. Among 26 patients,16(61.5%),4(15.4%) and 6(23.1%) underwent plain balloon dilation,balloon dilation plus cutting balloon dilation,and balloon dilation plus stenting,respectively. The technical success rate for PTA was 96.2% (25/26) without severe procedure related complications. During 12 month-72 month follow-up,blood pressure and the numbers of antihypertensive medications were significantly decreased (P<0.01),and serum creatinine did not change significantly. The primary restenosis rate at 1st,2nd,3rd,4th,5th,and 6th year was 17.4%,20.0%,25.0%,33.3%,33.3%,33.3%,respectively. Secondary PTA for restenosis was effective as well as. Conclusion PTA for symptomatic renal artery FMD is technically successful,safe and reliable,and effective on the blood pressure control in most of patients.

关 键 词：纤维肌性发育不良 肾血管性高血压 经皮肾动脉成形术 

分 类 号：R692[医药卫生—泌尿科学]