主动脉-肾动脉自体大隐静脉旁路术治疗大动脉炎性肾动脉狭窄33例分析  

Aortorenal bypass with autologous saphenous vein in Takayasu arteritis-induced renal artery stenosis： an analysis of 33 cases

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：《中华外科杂志》2011年第11期1011-1016,共6页Chinese Journal of Surgery

摘　　要：目的 分析主动脉-肾动脉自体大隐静脉旁路术治疗大动脉炎性肾动脉狭窄的近期及中长期疗效.方法 回顾性分析1997年3月至2009年3月采用主动脉-肾动脉大隐静脉旁路术治疗的连续33例大动脉炎性肾动脉狭窄患者的临床资料.其中男性9例,女性24例;年龄8 ～ 54岁,平均（25±11）岁;病程3～26个月,平均（9±5）个月.所有患者存在高血压,其中17例为难控性高血压,平均血压（ 175±26）/（100±19）mmHg（1 mmHg =0.133 kPa）,平均降压药物用量（2.1±0.6）个每日规定量（DDD）.3例合并充血性心力衰竭,1例依靠持续血液滤过治疗生存.术前估算肾小球滤过率为（78±5）mL/min.结果 共对39条肾动脉行旁路术治疗,包括单侧27例和双侧6例.肾动脉即时复通率100％.所有患者存活并成功随访12～146个月,平均（56±18）个月.随访过程中发生移植物闭塞2例,移植物狭窄4例,4例狭窄均通过经皮球囊扩张术成功治疗,其中1例6个月后发生再狭窄.1年、3年、5年一期通畅率分别为92％、89％、79％,一期辅助通畅率和二期通畅率相同,分别为95％、95％、91％.末次随访平均血压降至136/80 mmHg（P =0.000）,平均降压药物用量降为0.6 DDD（P =0.000）,平均估算肾小球滤过率增至91 ml/min（P =0.044）.3例充血性心力衰竭均缓解,1例肾功能不全患者不再依赖持续血液滤过治疗.结论 主动脉-肾动脉自体大隐静脉旁路术治疗大动脉炎性肾动脉狭窄近远期疗效确实,通畅率高.Objective To clarify the outcome of surgical reconstruction for renal artery in Takayasu arteritis-induced renal artery stenosis （TARAS）.Methods A retrospective chart review was conducted on 33 consecutive patients with TARAS,who underwent aortorenal bypass （ARB） with autologous saphenous vein graft.There were 9 male and 24 female patients,with a mean age of （ 25 ± 11 ） years.The effects on blood pressure and renal function were analyzed.Primary,primary assisted,and secondary patency rates were determined.The effects of various factors on primary patency rate were analyzed.All patients showed hypertension.The mean blood pressure was （ 175 ±26）/ （ 100 ± 19） mmHg （ 1 mmHg =0.133 kPa）.The mean antihypertensive dosage was （2.1 ± 0.6） defined daily dose （DDD）.Seventeen patients showed intractable hypertension.Mean estimated glomerular filtration rate was （78 ± 5） ml/min.One patient was dialysis-dependent,and 3 patients were combined with congestive heart failure.Results ARB was performed for the 39 renal arteries,including 27 unilateral and 6 bilateral bypasses.Postoperative morbidity was 15.2%.All patients survived.During follow-up of mean （56 ± 18） months,two graft occlusions and four graft restenoses occurred.All graft restenoses were eliminated successfully with percutaneous angioplasty,but one patient experienced restenosis again six months later.At 1,3,and 5 years of followup,primary patency was 92%,89%,and 79%,respectively,primary assisted patency was 95%,95%,and 91%,respectively,and secondary patency was 95%,95%,and 91%,respectively.ARB resulted in a decrease in mean blood pressure to 139/85 mmHg （one month post-ARB,P =0.000） and 136/80 mmHg （ last follow-up,P =0.000）,and a reduction in mean antihypertensive dosage to 1.4 DDD （one month post-ARB,P =0.084） and 0.6 DDD （ last follow-up,P =0.000）.Mean estimated glomerular filtration rate increased to 82 ml/min （ P =0.458 ） one month post-ARB,and 91 ml/min （ P =0.044） at last followup,respective

关 键 词：TAKAYASU动脉炎 血管外科手术 肾动脉梗阻 高血压 肾血管性 肾功能不全 

分 类 号：R654.3[医药卫生—外科学]