肾功能正常患者肾动脉狭窄支架置入术中栓子保护装置的作用

目的 研究肾功能正常时栓子保护装置(EPD)在肾动脉支架置入术中的应用价值.方法 将24例肾动脉狭窄(共26支肾动脉)接受肾动脉支架置入术患者(术前血清肌酐水平均在正常范围内)随机分为两组:EPD组(n=12,共13支肾动脉)和非EPD组(n=12,共13支肾动脉).所有患者于支架置入术前、术后1、6个月检测血清肌酐值,分别于组内手术前后及组间进行比较.结果 EPD组:支架置入术前、术后1、6个月的血清肌酐平均值分别为(99.18±18.26)μmol/L、(101.73±12.65)μmol/L、(96.82±15.81)μmol/L,相互间无显著性差异(P＞0.05).非EPD组支架置入术前、术后1、6个月的血清肌酐平均值分别为(100.18±19.81)μmol/L、(107.36±29.49)μmoL/L、(127.64±88.05)μmol/L,相互间无显著性差异(P＞0.05).两组间术前、术后1、6个月的血清肌酐平均值差异均无统计学意义(P＞0.05).结论 术前血清肌酐水平正常患者接受肾动脉支架置入术时,是否应用.肾动脉栓子保护装置对术后血清肌酐无明显影响.     

肾动脉支架成形术治疗肾动脉狭窄患者10年随访结果

目的 评价肾动脉支架成形术治疗动脉粥样硬化性肾动脉狭窄的远期疗效.方法 纳入连续收治的134例严重动脉粥样硬化性肾动脉狭窄患者(内径狭窄＞70％),并予以肾动脉支架成形术.记录患者术前、术后1年和2年血压及血清肌酐水平,同时测定肾小球滤过率(GFR)、10年后血压改变.结果 所有患者均成功接受介入治疗.与术前基线值比较,术后24 h肌酐升高[(109.8±24.6) μmol/L对(99.4±27.8) μmol/L],GFR降低[(57.6±19.3) ml/min对(68.5±18.9) ml/min)].患者术后1、2年平均肌酐值与术前基线值差异无统计学意义,但术后1、2、10年时分别有56例(50.9％)、50例(47.6％)和33例(44％)血压改善.结论 尽管肾动脉狭窄患者肾动脉支架成形术后肾功能无变化,但远期血压控制得到明显改善.     

评价栓子保护装置在肾动脉狭窄支架成形术中的应用价值

目的 探讨肾动脉狭窄支架成形术（RAS）中，应用栓子保护装置（EPD）的可行性和安全性。方法 对73例重度肾动脉狭窄患者行RAS，其中14例（17条肾动脉）术中使用EPD。所有73例在术前及术后1周均行肾功能检查。结果 14例使用EPD的患者，肾动脉支架置入及EPD使用均取得成功。支架释放前肾动脉的直径狭窄率为80．1％±9．0％，置入后为6．0％±4．2％，差异有统计学意义（t=26．422，P〈0．01）。回收的EPD滤网中，2例肉眼观察、9例显微镜下观察，均可见脱落的胆固醇碎片。结论 EPD能有效预防或减少远端栓塞事件的发生，在RAS中应用安全、有效。     

粥样硬化性肾动脉狭窄介入治疗的临床疗效分析

目的分析和观察粥样硬化性肾动脉狭窄(ARAS)患者介入治疗术后的临床疗效及影响因素。资料与方法对50例动脉粥样硬化患者65支肾动脉狭窄行经皮腔内肾动脉成形术(PTRA)(包括球囊扩张术和支架置入术),术后1个月、6个月、12个月、24个月随访血压、抗高血压药用药情况、血肌酐及再狭窄情况。结果 50例患者中,术后1、6、12个月全部成功随访,但术后24个月有15例失访。技术成功率为98%,术后1个月、6个月、12个月、24个月血压分别较术前有明显下降(P<0.05),血压控制的临床有效率(治愈+改善)分别为94%、74%、64%和51%,抗高血压药由术前平均3.5种,术后1个月、6个月、12个月平均下降分别为1种、2种、3种,24个月又恢复到3.5种。血清肌酐值与基础值相比无显著差异,术后6个月肾功能改善、稳定及恶化例数分别为12例(24%)、29例(58%)和8例(16%);术后12个月肾功能稳定及恶化例数分别为39例(78%)和11例(22%);术后24个月肾功能稳定及恶化例数分别为26例(74%)和8例(16%)。术后6个月、12个月、24个月支架内再狭窄发生率分别为6.8%、15%、20%。结论 PTR...     

肾动脉狭窄介入治疗中期疗效评价

目的 评价肾动脉狭窄介入治疗的临床疗效.方法 对47例(共55条狭窄肾动脉)患者行球囊导管扩张(PTRA)和(或)肾动脉支架置人(PTRS),随访血压及肾功能的变化情况.结果 54条肾动脉开通成功(54/55),17条肾动脉行单纯PTRA治疗,37条肾动脉行PTRS治疗.术中死亡1例,47例平均随访(2.5±0.6)年.术后1个月(46例)、6个月(46例)、1年(33例)、2年(29例)随访患者血压较术前有显著下降(P＜0.01),临床有效率分别为89.1%(41/46例)、72.7%(24/33例)、62.1%(18/29例).术后5例肾功能得到改善,33例保持不变,3例恶化.11例术前与术后(2个月内)肾图对比检查,8例肾脏血流灌注量增加,肾功能由重度受损改善为轻、中度受损,3例血流灌注仍为重度受损.结论 PTRA和PTRS可有效解决肾动脉狭窄,治疗肾性高血压和改善肾功能.     

肾动脉狭窄血管内治疗的临床疗效观察

目的　观察肾动脉狭窄血管内治疗的临床疗效。方法　对近 5年内 2 8例共 36支狭窄肾动脉行经皮肾动脉内支架成形术 (PTRAS)。术后 1个月、6个月、1年随访血压、血肌酐、抗高血压药用药情况 ,并与术前比较。术后 1年重复血管造影以判断再狭窄的发生率。结果　PTRAS技术成功率为10 0 % ,其原发通畅率为 82 % (肾动脉 86 % ) ,继发通畅率为 89% (肾动脉 90 % )。术后 1个月、6个月及 1年血压分别较术前有显著下降 (P <0 .0 1) ,血压控制的临床有效率 (治愈 改善 )分别为 10 0 %、92 .9%及 89.3% ;血清肌酐值、抗高血压药数目与基础值相比无显著差异。术后 1年 ,有 4例 (14 .3% )肾功能得到改善 ,18例 (6 4 .3% )肾功能保持稳定 ,6例 (2 1.4 % )肾功能恶化 ,其中 4例术前有肾功能不全病史 ;并发症包括 1例穿刺部位血肿及 3例一过性肾功能减退。结论　PTRAS操作简单、并发症少、技术成功率高、临床疗效佳 ,是肾动脉狭窄较为理想的首选治疗方法之一。     

肾动脉狭窄支架术围手术期降压药物的应用

目的 评价降压药物在.肾动脉支架围手术期治疗中的作用.方法 93例肾动脉狭窄支架置入术患者,术前术后以钙拮抗剂为首选的降压药物,配合使用血管紧张素转换酶抑制剂(ACEI)及肾上腺素能受体结合剂(ARB)类控制血压.以140/90 mm Hg为目标血压,观察血压达标的情况,观察术后肾功能情况.结果 患者术前降压药物使用种类平均为(2.6±0.9)种,术后降压药应用种类为(1.9±0.9)种,术前血压达标为28%,术后达标为68%.结论 以钙拮抗剂为主的药物治疗方案,对于控制肾动脉支架围手术期血压是安全有效的.ACEI及ARB类药物对于肾动脉支架术后患者可以安全使用.     

肾动脉支架成形术对血压、肾功能影响及其临床应用价值

目的：探讨肾动脉支架成形术对患者血压、肾功能的影响及其应用价值。方法140例动脉硬化性肾动脉狭窄行肾动脉支架成形术患者,其中男85例（60．7％）,女55例（39．3％）。年龄47～86岁,平均（67．4±9．82）岁。共施行了152条肾动脉支架置入,12例为双侧肾动脉分期介入治疗。分析手术并发症,随访患者的血压变化、服用降压药物种类及血肌酐、尿素氮变化,超声观察支架通畅情况。结果手术成功率100％。围术期并发症：肾周血肿5例（3．3％）;穿刺部位血肿5例（3．3％）;术后上消化道出血2例（1．3％）。围术期死亡1例（0．6％）。随访时间24个月,高血压患者服用降压药种类从术前平均（2．9±1．2）种下降至（1．9±1．3）种（P＜0．05）。总体上,高血压治愈0例,改善108例（77．1％）,无效32例（22．9％）。介入手术后患者血压有所改善[术前收缩压（150．04±16．69） mmHg,术后（137．05±12．58） mmHg,P＜0．001;术前舒张压（81．69±12．02）mmHg,术后（79．29±8．71）mmHg,P＜0．05];133例术前肾功能正常患者术后血清肌酐尿素氮检测低于术前水平[术前血肌酐（91．63±38．06）μmol/L,术后（87．69±40．31）μmol/L,P＜0．001;术前尿素氮（5．97±1．80） mmol/L,术后（5．63±1．83） mmol/L,P＜0．05];7例术前肾功能不全患者介入治疗后肌酐尿素氮水平无明显改善。结论肾动脉支架成形术可以使肾动脉狭窄合并高血压患者的血压得以减轻或易于控制,同时有利于维持肾功能正常。     

大动脉炎性肾动脉狭窄支架植入术的疗效分析

目的研究经皮腔内血管成形术 内支架植入术治疗大动脉炎性肾动脉狭窄所致肾性高血压的临床效果。资料与方法选用Palmaz支架和AVEBridge支架,对18例大动脉炎所致肾动脉狭窄先行经皮腔内肾动脉成形术(PTRA),然后放置支架。术后检测血管的内径和术后一周时血压的变化。结果18例PTRA 支架植入术技术成功率100%。血管内径由术前平均为(1.7±0.6)mm恢复至术后为(5.3±0.4)mm,术后1周时血压由术前的(22.7±3.3/14.0±2.1)kPa降为(19.3±1.6/10.4±2.0)kPa,其中10例血压恢复正常,6例血压改善。术后随访肾动脉血流通畅,血压控制满意。结论PTRA 支架植入术治疗大动脉炎性肾动脉狭效果满意,创伤小,患者痛苦少;PTRA 支架术是目前治疗大动脉炎性肾动脉狭窄的首选方法,具有安全、简便、有效的优点。     

端-端吻合型移植肾动脉狭窄的介入治疗

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.     

Renal tumor versus renal cyst

The precise diagnosis of carcinoma of the kidney is of particular importance because renal mass lesions are frequently encountered which require nephrectomy if malignant, and renal tissue conservation if benign. The diagnostic problems include those of differentiating benign from malignant tumors and tumors from cysts. Delineation of the extent of tumors is also essential for treatment planning and prognostic implications. Although the sequence of diagnostic imaging procedures utilized in suspected renal mass lesions varies somewhat depending on the clinical presentation, the following techniques are frequently employed until the relevant questions have been answered: urography, ultrasound and/or computed tomography, cyst puncture and contrast injections, angiography, and renal venography. These non-operative methods usually clarify the nature and extent of renal mass lesions and therefore have a major effect on therapy. A logical, systematic approach to their application avoids duplication and achieves approapriate diagnosis most rapidly. Part II will appear in Volume 1, Number 2, 1978     

超选择肾动脉栓塞术治疗晚期肾癌(附19例分析)

目的减少肾癌根治术中出血,提高切除率及晚期肾癌患者的姑息治疗疗效。材料与方法应用明胶海绵、碘化油等栓塞材料超选择肾动脉栓塞辅助治疗19例肾癌。结果栓塞后72小时内行根治术者15例,2例栓塞术前未能切除或放弃手术而栓塞后得以切除,另外2例栓塞术后拒绝外科手术。术后30天生存率100％,1、3年生存率分别为79％、57％。本组未见并发症。结论肾动脉栓塞术治疗晚期肾癌安全有效,可用于肾癌术前的辅助治疗及肾癌晚期的姑息治疗。     

非洛地平与福辛普利治疗肾移植术后高血压疗效比较

 目的比较非洛地平(波依定)和福辛普利(蒙诺)治疗肾移植术后高血压的疗效及降压以外的作用.方法入选肾移植术后收缩压≥140 mmHg和(或)舒张压≥mmHg的患者67例,随机分为非洛地平组(n=33)和福辛普利组(n=34).非洛地平组口服非洛地平2.5～10mg,1/d,如血压未降至140/90 mmHg以下,稳定剂量服用1周以后可加用福辛普利治疗;福辛普利组口服福辛普利5～10mg,1/d,如血压仍高于140/90 mmHg,在稳定剂量服用1周后可加用非洛地平治疗.随访4个月.观察血压、血肌酐及血红蛋白的变化.结果非洛地平和福辛普利降压效果相似(P＞0.05).但两者合用后血肌酐低于单用非洛地平亚组(P=0.013)和单用福辛普利亚组(P=0.010),血肌酐分别为(115.9±12.1)μmol/L、(131.0±21.1)μmol/L、(127.3±11.0)μmol/L.非洛地平组术后肾功能恢复时间低于福辛普利组(P=0.031),分别为(4.5±0.8)d和(5.0±0.8)d.单用非洛地平组发生红细胞增多症2例,多于联合应用福辛普利组(0例),进行亚组分析,有统计学意义(P=0.026).结论肾移植术后高血压应用非洛地平和福辛普利联合治疗效果较好,且可以保护肾功能,预防红细胞增多症的发生.     

T2 weighted MRI for assessing renal lesions in transgenic mouse models of tuberous sclerosis

Objective

Transgenic mouse models of tuberous sclerosis (TSC) develop renal cysts, cystadenomas, solid adenomas and carcinomas. Identification and characterisation of these lesions in vivo may help in TSC pre-clinical trials. This study was to evaluate T2 weighted MRI for assessment of renal lesions in two Tsc mouse models.

Materials and Methods

Tsc1^+/−, Tsc2^+/− and wild type mice were subjected to a first MRI scan at 12 months of age and a second scan 2 months later. One Tsc2^+/− mouse was treated with rapamycin for two months after the initial scan. Immediately following the second scan, mice were sacrificed and MRI images were compared to renal histological findings.

Results

MRI identified all types of Tsc-associated renal lesions in both Tsc1^+/− and Tsc2^+/− mice. The smallest detectable lesions were <0.1 mm³. Eighty three percent of all renal lesions detected in the first scan were re-identified in the second scan. By MRI, these lesions demonstrated significant growth in the 9 untreated Tsc1^+/− and Tsc2^+/− mice but shrinkage in the rapamycin treated Tsc2^+/− mouse. Between the two scans, MRI also revealed significant increase in both the total number and volume of lesions in untreated mice and decrease in the rapamycin treated mouse, respectively. In comparison to histological analysis MRI detected most cysts and cystadenomas (66%) but only a minority of solid tumours (29%).

Conclusion

These results suggest that T2 weighted MRI may be a useful tool for assessing some renal lesions in pre-clinical studies using Tsc mouse models. However, improved sensitivity for T2 weighted MRI is required, particularly for solid renal lesions.     

经导管肾动脉栓塞的临床应用(附53例报告)

目的：对肾肿瘤及肾出血行肾动脉栓塞术的疗效及技术进行评价。方法：以明胶海绵、NT—CRE、线段、自体凝血块及无水乙醇用于栓塞肿瘤、先天性肾动静脉瘘和肾外伤出血，共53例。结果：41例术前辅助治疗的肾肿瘤在肾动脉栓塞后均成功进行了肾切除术，手术中平均输血405ml。4例晚期肾癌姑息性栓塞治疗者术后分别存活了3．5、13、17和25个月。1例先天性肾动静脉瘘和4例肾外伤出血在栓塞术后出血迅速停止，另1例先天性肾动静脉瘘出血，行超选择肾段动脉栓塞无效后又行肾切除术。结论：肾动脉栓塞术安全有效，可用于肾肿瘤的术前辅助治疗、晚期肾癌的姑息治疗及先天性肾动静脉瘘和肾外伤出血的治疗。     

The Appropriateness of Renal Angioplasty. The ANPARIA Software: A Multidisciplinary Expert Panel Approach

Percutaneous transluminal renal angioplasty (PTRA) is an invasive technique that is costly and involves the risk of complications and renal failure. The ability of PTRA to reduce the administration of antihypertensive drugs has been demonstrated. A potentially greater benefit, which nevertheless remains to be proven, is the deferral of the need for chronic dialysis. The aim of the study (ANPARIA) was to assess the appropriateness of PTRA to impact on the evolution of renal function. A standardized expert panel method was used to assess the appropriateness of medical treatment alone or medical treatment with revascularization in various clinical situations. The choice of revascularization by either PTRA or surgery was examined for each clinical situation. Analysis was based on a detailed literature review and on systematically elicited expert opinion, which were obtained during a two-round modified Delphi process. The study provides detailed responses on the appropriateness of PTRA for 1848 distinct clinical scenarios. Depending on the major clinical presentation, appropriateness of revascularization varied from 32% to 75% for individual scenarios (overal 48%). Uncertainty as to revascularization was 41% overall. When revascularization was appropriate, PTRA was favored over surgery in 94% of the scenarios, except in certain cases of aortic atheroma where sugery was the preferred choice. Kidney size >7 cm, absence of coexisting disease, acute renal failure, a high degree of stenosis (≥70%), and absence of multiple arteries were identified as predictive variables of favorable appropriateness ratings. Situations such as cardiac failure with pulmonary edema or acute thrombosis of the renal artery were defined as indications for PTRA. This study identified clinical situations in which PTRA or surgery are appropriate for renal artery disease. We built a decision tree which can be used via Internet: the ANPARIA software (/). In numerous clinical situations uncertainty remains as to whether PTRA prevents deterioration of renal function.     

Prognostic value of renal vascular impedance in patients with hepatic cirrhosis in risk for developing hepatorenal syndrome

Aim of the work

To evaluate the intrarenal arterial changes in patients with hepatic cirrhosis to anticipate development of hepatorenal syndrome.

Materials and methods

Study population included 155 subjects divided into five groups; group (1): control subjects; group (2): patients with compensated cirrhosis; group (3): patients with decompensated cirrhosis without ascites; group (4): patients with decompensated cirrhosis and ascites; and group (5): patients with hepatorenal syndrome.

Results

In group 5; the mean value of RI was significantly high as well as groups 4 and 3, as related to groups 2 and 1. The PI was significantly high in groups 5, 4, and 3, as related to groups 2 and 1. High RIs were received in 83% of group 5, 56% of group 4, 41% of group 3, 32% of group 2, and 8% of group 1. On the other hand, high PIs were received in 83% of group 5, 78% of group 4, 71% of group 3, 41% of group 2, and 3% of group 1. Renal vascular impedance measurement had sensitivity of 71%, specificity of 96%, PPV of 92%, and NPV of 86%.

Conclusion

Renovascular impedance values are good specific and positive predictive tools for hepatorenal syndrome development in patients with hepatic cirrhosis.     

肾癌术前无水乙醇肾动脉栓塞及并发症的预防(附48例报告)

目的：研究肾癌术前无水乙醇肾动脉栓塞，以减少肾癌术中出血，避免肿瘤扩散。方法：ｓｅｌｄｉｎｇｅｒ法，导管插入患肾动脉，以１ｍｌ／ｓ注射无水乙醇第１个５ｍｌ，０．５ｍｌ／ｓ注射第２个５ｍｌ，０．２ｍｌ／ｓ注射余下部分——呈递减速度注射无水乙醇１５～２０ｍｌ。结果：４６例栓塞成功，２例失败；１例无水乙醇返流导致肠系膜下动脉栓塞。结论：肾癌术前无水乙醇肾动脉栓塞安全、有效；以递减速度注射，可预防无水乙醇返流造成其他脏器栓塞的并发症。     

肾移植术后血管并发症的介入治疗

目的 探讨肾移植术后血管并发症介入治疗的价值。资料与方法 14例肾移植患者中，11例移植肾动脉狭窄，行球囊扩张或支架置入术；2例假性动脉瘤，行导管栓塞术；1例移植肾动脉血栓形成，行导管动脉溶栓术。结果 11例移植肾动脉狭窄患者均成功完成球囊扩张术，其中3例行支架置入术，术后患者血压均恢复正常，随3－35个月，未见狭窄；2例假性动脉瘤患者行栓塞术后，1例血流恢复正常，1例行移植肾摘除；1例移植肾动脉溶栓者，由于并发出血行移植肾摘除。结论 介入治疗是肾移植术后血管并发症有效的治疗方法。