采用单条大隐静脉行腹主动脉-双侧肾动脉旁路术治疗大动脉炎性肾动脉狭窄  

Aorto-birenal bypass with single saphenous vein for Takayasu arteritis-induced renal artery stenosis

作　　者：冯睿[1] 魏小龙[1] 赵志青[1] 包俊敏[1] 冯翔[1] 曲乐丰[1] 陆清声[1] 陆华[1] 景在平[1] 

机构地区：[1]第二军医大学附属长海医院血管外科,上海200433

出　　处：《外科理论与实践》2011年第2期151-154,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:研究采用单条大隐静脉行腹主动脉-双侧肾动脉旁路术治疗大动脉炎性双侧肾动脉狭窄的疗效。方法:回顾性分析采用该术式治疗的11例大动脉炎性双侧肾动脉狭窄的连续临床资料。结果:所有病人术前均表现为难控性高血压,1例需依赖血透生存。11例均顺利完成手术,22条肾动脉即刻复通,无围手术期死亡。平均随访时间为45个月。末次随访时平均血压由术前的195/109 mm Hg降至132/83 mm Hg(P<0.05);平均降压药物用量由术前的2.8 DDD降为0.7 DDD(P<0.05);平均估算肾小球滤过率由术前的68 mL/min增至89 mL/min(P<0.05);术前血透依赖者不再需要进行血透。未发现移植物闭塞或>50%的再狭窄。结论:该术式是治疗双侧大动脉炎性肾动脉狭窄之安全、有效的方法;可有效降压和改善肾功能;中远期通畅率高。Objective To study the outcome of aorto-birenal bypass（ABRB） with a single saphenous vein for treating bilateral Takayasu arteritis-induced renal artery stenosis（TARAS）.Methods A retrospective review was conducted on 11 consecutive patients with bilateral TARAS,who underwent ABRB with a single saphenous vein graft.Results All patients showed intractable hypertension pre-operatively,and one patient was dialysis-dependent.After the ABRB,immediate renal revascularization was achieved in all the 22 bilateral renal arteries.All patients survived.The mean follow-up period was 45 months.ABRB resulted in a decrease in mean blood pressure from 195/109 mm Hg to 132/83 mm Hg（P0.05）;the mean antihypertensive drug dosage decreased from 2.8 DDD to 0.7 DDD（P0.05）;the mean estimated glomerular filtration rate increased from 68 ml/min to 89 ml/min（P0.05）.The dialysis-dependent patient no longer required hemodialysis.No graft occlusion or ≥50% restenosis occurred.Conclusions ABRB is a safe and effective method for treating bilateral TARAS,providing remarkable mid-to long-term patency,and lending improvement to blood pressure control and renal function.

关 键 词：多发性大动脉炎 肾动脉狭窄 肾性高血压 肾功能 旁路术 

分 类 号：R654.3[医药卫生—外科学]