血管内多技术联合应用治疗急性肾动脉闭塞的初步经验  

Endovascular combination use of multiple interventional techniques for acute renal artery occlusion:initial experience

作　　者：王绍显 刘圣[1] 贾振宇[1] 刘兴龙[1] 王斌[1] 周春高[1] 施海彬[1] WAGN Shaoxian;LIU Sheng;JIA Zhenyu;LIU Xinglong;WAGN Bin;ZHOU Chungao;SHI Haibin(Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科

出　　处：《介入放射学杂志》2019年第6期537-541,共5页Journal of Interventional Radiology

基　　金：江苏省“六大人才高峰”高层次人才项目(WSW-010)

摘　　要：目的评价血栓抽吸术、导管接触溶栓(CDT)、支架取栓等技术联合应用治疗急性肾动脉闭塞(ARAO)的有效性,初步探讨影像学检查对治疗的指导价值。方法2014年1月至2016年12月,8例确诊为ARAO患者在南京医科大学第一附属医院接受多种技术血管内再通治疗。回顾性分析患者手术前后临床症状以及血压、实验室检查、影像学检查结果等临床资料。结果8例ARAO患者均实现了肾动脉血运完全或部分重建,其中3例肾动脉主干闭塞患者中2例接受Solitaire AB支架取栓联合CDT治疗,1例接受血栓抽吸术联合CDT治疗;2例肾动脉主干闭塞伴肾动脉近端严重狭窄患者接受支架取栓联合CDT治疗;3例接受单纯CDT治疗。治疗后40 h内所有患者腹痛缓解,收缩压由(142.0±20.8)mm Hg(1 mmHg=0.133 k Pa)降至(126.9±7.5)mm Hg(P=0.052),实验室检查显示肾功能改善。随访增强CT表明受累的肾动脉及肾皮质灌注部分恢复。结论在一定时间窗内联合应用多模式个体化血管内治疗方案对ARAO血运重建安全有效,增强CT扫描强化肾实质可能为个体化治疗提供依据。Objective To evaluate the effectiveness of endovascular combination use of multiple interventional techniques,including thrombus aspiration,catheter-directed thrombolysis(CDT),stent thrombectomy and so on,for acute renal artery occlusion(ARAO),and to discuss the guiding value of imaging examination in formulating clinical treatment.Methods Between January 2014 and December2016,a total of 8 patients with confirmed ARAO were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive endovascular revascularization treatment by using multiple interventional techniques.The clinical data,including preoperative and postoperative clinical symptoms,blood pressure,laboratory tests,imaging findings,etc.,were retrospectively analyzed.Results Complete or partial revascularization of renal artery was achieved in all 8 ARAO patients.Among the 8 patients,3 patients received mechanical thrombectomy by using Solitaire AB stent together with catheter-directed thrombolysis(CDT),one patient received thrombus aspiration combined with CDT,2 patients,who had occlusion of main renal artery with severe stenosis of proximal renal artery,received stent thrombectomy plus CDT,and 3 patients received simple CDT.Abdominal pain relief was obtained in all patients within 40 hours after treatment.The systolic blood pressure decreased from preoperative(142.0±20.8)mmHg(1 mmHg=0.133 k Pa)to postoperative(126.9±7.5)mm Hg(P=0.052).Laboratory examinations showed that the renal function was improved.Follow-up contrast-enhanced CT scan indicated that the affected renal arteries and renal cortical perfusion were partially recovered.Conclusion Within a certain time window,individualized endovascular therapeutic regimen with combination use of multiple interventional techniques is safe and effective for obtaining the revascularization in treating patients with ARAO.Contrast-enhanced CT scan of kidney may provide useful information for individualized treatment.

关 键 词：急性肾动脉闭塞 血栓抽吸术 导管接触溶栓 支架取栓 增强CT 

分 类 号：K541[历史地理—历史学]