端-端吻合型移植肾动脉狭窄的介入治疗  

Interventional treatment for transplant renal artery stenosis of end to end anastomosis type

作　　者：孙志超[1] 肖湘生[2] 许茂盛[1] 孟小茜[2] 刘洪超[2] 董伟华[2] 

机构地区：[1]浙江中医药大学附属第一医院医学影像科,浙江杭州310006 [2]上海长征医院影像科,上海200003

出　　处：《医学影像学杂志》2014年第3期470-473,共4页Journal of Medical Imaging

摘　　要：目的 探讨经皮血管成形术治疗端-端吻合型移植肾动脉狭窄的疗效.方法 以经皮血管腔内成形术（PTA）和/或支架置入术对16例端-端吻合型TRAS患者行介入治疗,TRAS患者从肾移植到出现肾动脉狭窄症状平均6.3个月（3～18个月）,记录经皮血管成形术（PTA）前后血压变化和肌酐水平并随访.结果 16例TRAS患者共行23次PTA（行1次PTA 10例,2次5例,3次1例）,PTA治疗前肾动脉狭窄率为70％～95％,PTA后狭窄率小于30％.PTA前收缩压（179.6±15.2）mmHg,舒张压（115.4±11.3）mmHg;PTA后收缩压降为（155.6±13.5）mmHg,舒张压降为（95.6±6.7）mmHg.平均血肌酐从术前（426.8±38.5）μmol/L降为术后（142.5±15.2μmol/L,首次PTA后再狭窄率37.5％.术后随访3～24个月（平均12个月）.16例中最终治愈4例,改善9例,好转2例,无效1例.结论 经皮球囊成形术治疗端-端吻合型移植肾动脉狭窄安全有效,支架植入应谨慎选择.Objective To evaluate the treatment of transplanted renal artery stenosis （TRAS） of end to end anastomosis type by percutaneous transluminal angioplasty （PTA） and stent placement.Methods 16 patients of end to end anastomosis type TRAS were accepted interventional treatment （PTA and/or stent）.The average time from transplantation to the symptom of TRAS was 6.3 months （3～18 months） in 16 patients.Creatinine level and BP （blood pressure） were monitored before and after the procedure.Results 23 PTA procedures were performed on 16 patients with TRAS （one time PTA for ten patients,2 times of PTA for 5 patients,3 times of PTA for 1 patient）.The transplanted renal artery stenosis rate decreased from 70 ％ ～95 ％ preoperatively to less than 30 ％ postoperatively.And the systolic blood pressure and diastolic blood pressure decreased respectively from （179.6±15.2） mmHg,（115.4±11.3） mmHg to （155.6±13.5） mmHg,（95.6±6.7） mmHg （P ＜0.05）,meanwhile,the average serum creatinine level dropped from （426.8±38.5） μmol/L to （142.5 ±15.2） μmol/L （P ＜0.05）.The restenosis rate after first treatment was 37.5 ％.Of the 16 cases,4 were finally healed,9 wree ameliorated,2 were improved,and 1 was inefficiency.Conclusion The PTA is effective and safe for TRAS with high rates of procedure success and efficacy.Stent placement should be careful to choose.

关 键 词：血管成形术 移植肾动脉狭窄 肾移植 疗效 

分 类 号：R692[医药卫生—泌尿科学] R815[医药卫生—外科学]