肾动脉狭窄介入治疗的疗效分析

目的评价经皮肾动脉成形术血运重建对于肾动脉狭窄患者的血压、肾功能等方面的影响。方法2004年2月-2008年4月我院收治的肾动脉狭窄患者201例（管腔狭窄≥70％），经肾动脉成形术重建。肾动脉血运。其中138例患者术后平均随访（13±10）月，观察其血压、降压药物、肾功能的变化。结果201例患者肾动脉成形术成功率96％。病变动脉管腔直径狭窄率由70％±11％降至12％±10％。术后随访138例患者血压下降有统计学意义（P〈0．01），收缩压由（20．1±3．3）kPa降至（18．3±2．1）kPa，舒张压由（10．9±2．0）kPa降至（10．3±1．5）kPa；口服降压药品种减少（P〈0．01），由平均（2．4±1．2）种降至（1．8±0．9）种；术后1至23个月发生支架内再狭窄14例，非开口病变是再狭窄的危险因素。结论肾动脉狭窄患者经皮肾动脉成形术的手术成功率高，并有助于此类患者血压的长期控制，支架内再狭窄与肾动脉狭窄病变部位相关。

Therapeutic effect of renal artery revascularization on renal artery stenosis

Objective To observe the effect of renal artery angioplasty on blood pressure and kidney function in patients with renal artery stenosis （RAS）. Methods A total of 201 patients with RAS received percutaneous transluminal renal artery angioplasty/stents （PTRAS）. One hundred and thirty-eight patients were followed up for an average period of 13 ± 10 months to observe changes occurred in their blood pressure, serum creatinine level, and glomerular filtration. Results Renal artery angioplasty was successfully performed in 96% of the 201 patients. The renal artery stenosis rate was decreased from 70% ± 11% to 12%±10% after PTRAS. The blood pressure of 138 followed-up patients was significantly decreased （P 〈 0.01 ）. The number of anti-hypertensive drugs was significantly decreased （ P 〈 0.01 ）. The systolic blood pressure was decreased from （20.1 ± 3.3 ） kPa to （ 18.3± 2.1 ） kPa, while the diastolic systoli pressure was decreased from （ 10.9 ± 2.010） kPa to （3± 1.5 ） kPa. Instent restenosis occurred in 14 patients 1 to 23 months after operation, which was correlated with nonostial stenosis. Conclusion Patients with renal artery stenosis can benefit from PTRAS and instent restenosis is correlated with the type of RAS.