经皮腔内血管成形术联合支架置入治疗移植肾动脉狭窄的临床分析  

Clinical analysis of percutaneous transluminal angioplasty combined with stent implantation in the treatment of transplant renal artery stenosis

作　　者：顾世杰 陈秋源 崔瑞文 马晴 马麟 石小红 孟凡航 曹荣华 Gu Shijie;Chen Qiuyuan;Cui Ruiwen;Ma Qing;Ma Lin;Shi Xiaohong;Meng Fanhang;Cao Ronghua(Department of Organ Transplantation,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China;不详)

机构地区：[1]广州中医药大学第二附属医院器官移植科,510120 [2]广州中医药大学第二附属医院影像科,510120

出　　处：《器官移植》2021年第2期215-219,共5页Organ Transplantation

基　　金：广东省医学科学技术研究基金(2019KT1252);广东省科技计划项目研究基金(2016KT1167)。

摘　　要：目的探讨经皮腔内血管成形术(PTA)联合支架置入治疗肾移植术后移植肾动脉狭窄(TRAS的临床疗效。方法回顾性分析21例肾移植术后TRAS行PTA联合支架置入治疗患者的临床资料。总结肾移植受者中TRAS的发生情况,比较TRAS患者介入治疗前后相关指标变化情况,分析TRAS患者的预后情况。结果507例肾移植受者中有21例发生TRAS,发生率为4.1%(21/507)。TRAS诊断时间为术后5(4,7)个月,67%(14/21)在术后6个月内出现TRAS。与介入治疗前比较,介入治疗后1周和1个月TRAS患者血清肌酐、收缩压、舒张压以及移植肾动脉峰值血流流速均降低,估算肾小球滤过率(eGFR)、叶间动脉阻力指数均升高,差异均有统计学意义(均为P<0.05)。PTA联合支架置入术后随访期间,共有1例出现移植肾动脉再发狭窄,经单纯球囊扩张后好转,1例右股动脉穿刺点假性动脉瘤形成,1例移植肾动脉闭锁导致肾脏萎缩失功,其余18例术后均恢复良好。结论PTA联合支架置入是肾移植术后TRAS首选治疗方式,可明显改善移植肾功能,显著延长移植肾的生存时间。Objective To evaluate the clinical efficacy of percutaneous transluminal angioplasty(PTA)combined with stent implantation in the treatment of transplant renal artery stenosis(TRAS)after renal transplantation.Methods Clinical data of 21 patients with TRAS after renal transplantation undergoing PTA combined with stent implantation were retrospectively analyzed.The incidence of TRAS in renal transplant recipients was summarized.The changes of relevant indexes in patients with TRAS were statistically compared before and after interventional treatment.Clinical prognosis of patients with TRAS was evaluated.Results The incidence of TRAS in renal transplant recipients was 4.1%(21/507).TRAS was diagnosed at postoperative 5(4,7)months,and 67%(14/21)of patients developed TRAS within postoperative 6 months.Compared with the values before interventional therapy,the serum creatinine level,systolic and diastolic blood pressure and peak flow velocity of transplant renal artery of patients with TRAS were significantly decreased,and the estimated glomerular filtration rate(eGFR)and interlobar arterial resistance index were significantly increased at 1 week and 1 month after interventional therapy(all P<0.05).During postoperative follow-up after PTA combined with stent implantation,1 patient suffered re-stenosis of the transplant renal artery,which was improved after simple balloon dilatation.One patient developed pseudoaneurysm formation at the puncture site of the right femoral artery.One patient presented with renal atrophy and loss of function due to atresia of the transplant renal artery.All the remaining 18 patients were well recovered after surgery.Conclusions PTA combined with stent implantation is the optimal treatment of TRAS after renal transplantation,which can significantly improve the function of transplant kidney and considerably prolong the survival time of transplant kidney.

关 键 词：肾移植 移植肾动脉狭窄(TRAS) 血管造影 经皮腔内血管成形术(PTA) 支架置入 单纯球囊扩张 

分 类 号：R617[医药卫生—外科学] R692[医药卫生—临床医学]