肾动脉狭窄经皮扩张术

作者报道了肾动脉狭窄经皮气囊扩张术的结果。在7例病人中进行过8次,其中一例两侧分别先后发现肾动脉狭窄。经二年随访未发现任何并发症,因而肯定了疗效的稳定。在单侧肾动脉狭窄的4例中,动脉扩张术完成后12小时,血压恢复正常。若除肾动脉狭窄外,还在其他引起高血压的原因,则动脉扩张术不能把血压恢复到正常,仅管动脉造影证实狭窄业     

经皮腔内肾动脉成形术及自体肾移植治疗肾血管性高血压(附7例报告)

自1980到1986年,我院泌尿外科对4例单纯右侧肾动脉狭窄(RAS)性和3例双侧RAS性高血压病人进行了治疗。7例右侧 RAS皆进行了自体肾移植治疗,其中3例双侧RAS者采用PTA治疗,全部病人术后8天内血压皆恢复正常,随诊10个月到6年,无复发且都恢复工作。1例17岁女孩,术后2年结婚,又2年生一女孩,母女健在血压维持正常。     

小儿布—加综合症的诊断和治疗

小儿布—加综合症(BCS)临床报道较少,1988～1991年我院手术治疗8例。经消化道钡餐检查者6例,其中4例显示明显食道静脉曲张。血管造影显示:8例均有不同程度下腔静脉狭窄,其中2例伴有 MOVC;4例显示中度或重度肝静脉狭窄;3例为肝静脉阻塞。指出经右心房手指破膜术和球囊导管破膜术是简单、安全和有效的治疗方法。随访1/2～3年均恢复顺利,仅1例于肠腔侧侧吻合术后并发肝性脑病,经治疗而愈。肝大(除1例外)及食管静脉曲张患者,均于手术后2～3个月临床症状完全消失。     

颅内外动脉狭窄支架成型术防治缺血性脑卒中临床研究

目的：探讨颅内外动脉狭窄支架成型术在防治缺血性脑卒中的应用。方法：将96例缺血性脑卒中患者通过颅脑磁共振血管成像及颈部血管超声进行初步筛选,再行全脑血管造影。对狭窄程度〉70%或〉50%的症状性狭窄施行支架成型术,并对手术操作、术后并发症及疗效进行评估。结果：96例有38处狭窄,成功置入39枚支架。置入支架后造影见血管狭窄明显改善,术后症状均好转,无1例加重。7例患者术后3～8个月CTA或全脑血管造影随访显示,仅1例出现支架置入部位再狭窄。结论：采用动脉支架成型解除动脉狭窄,以从源头上防治缺血性脑卒中,且手术安全性较高。     

术前脑血管造影在血管内支架成形术治疗缺血性脑血管病中的应用

目的：探讨术前脑血管造影在血管内支架成形术治疗脑供血动脉狭窄中的应用价值。方法：对105例症状性脑缺血发作患者进行术前全脑血管造影。对136支狭窄的血管进行了血管内支架成形术。术后不同时期进行脑血管造影随访。结果：105例患者术前共存在136处狭窄血管,支架治疗术后70处血管狭窄恢复了正常血管直径,54处残余狭窄小于20%,7处残余狭窄界于50%～80%之间,有5例因支架不能到位,放弃手术。术中血栓保护伞完全被封堵住1例。所有患者术前症状均有不同程度的缓解,70例患者获得术后1～24个月的脑血管造影随访,其中颈动脉再狭窄2例,椎动脉起始部再狭窄6例,颅内动脉再狭窄6例。结论：术前进行充分的脑血管造影评估,以制定个体化的治疗方案,可以提高血管内支架成形术的安全性。     

肾动脉狭窄性高血压的临床特点及经皮肾动脉介入治疗的效果分析

目的 探讨肾动脉狭窄性高血压患者的临床特点及经皮肾动脉介入治疗的效果.方法对10例肾动脉狭窄性高血压患者的临床特点及经皮肾动脉介入治疗的效果进行回顾性分析.结果 10例患者中动脉粥样硬化6例,纤维肌性发育不良3例,大动脉炎1例.10例患者均伴有高血压,其中顽固性高血压8例、急进性高血压2例.肾动脉造影结果显示:6例动脉粥样硬化性肾动脉狭窄患者中4例为双侧肾动脉狭窄,狭窄部位位于左、右肾动脉开口处或近段,狭窄程度80%~90%;1例为右肾动脉狭窄,1例为左侧肾动脉,部位位于肾动脉近段,狭窄程度75%~80%.3例肌纤维发育不良性肾动脉狭窄患者均为单侧肾动脉病变,均为右侧,位于肾动脉远段,狭窄程度80%.1例大动脉炎性肾动脉狭窄患者为双侧肾动脉病变,位于肾动脉近段,狭窄程度85%.所有患者于狭窄病变处行支架植入治疗.4例患者(3例为纤维肌发育不良性,1例为大动脉炎)术后1周内血压恢复正常;其余6例患者中血压较前明显改善.2例术前合并肾功能不全患者术后1周肾功能明显改善.结论 肾动脉狭窄性高血压有其特殊的临床特征,经皮肾动脉介入治疗是一种有效的治疗方法.     

16层螺旋CT动脉造影对肾血管性高血压病诊断的临床应用

目的探究肾血管性高血压病早期诊断的检查方法,并研究16层螺旋CT动脉造影技术对肾动脉狭窄的检出率。方法收集2011年1月~2012年6月我院收治的疑似肾血管性高血压病患者19例,综合分析患者的血压水平、家族遗传病史,采用16层螺旋CT动脉造影对疑似病例进行检查,分析其应用价值。结果 19例患者经过多层螺旋CT动脉造影检查后,肾血管正常者6例,13例显示不同程度肾动脉狭窄,其中,起始段狭窄9例,肾动脉中端狭窄4例;轻度狭窄2例,中度狭窄4例,重度狭窄6例,血管闭塞1例;局限性狭窄10例,全程性狭窄3例。结论 16层螺旋CT动脉造影能清晰的显示肾动脉主干及分支狭窄程度及范围,值得临床推广应用。     

髂股动脉硬化闭塞症的介入治疗

目的评价髂股动脉硬化闭塞性病变的介入治疗的疗效,总结其适应症,探讨并发症的防治。方法回顾性分析62例髂股动脉狭窄或闭塞的血管造影与介入治疗资料,其中急性发病18例,慢性发病44例;经球囊扩张或植入支架治疗,并进行临床及血管造影随访。结果62例患者介入治疗60例获成功,成功率达97%。获得成功治疗60例患者70条动脉,单纯球囊扩张42条动脉,术后血管直径可达正常的80%以上。球囊扩张后植入支架共有28条动脉。术后60例患者随访6～36个月。在随访中,绝大部分患者临床表现好转。术后6个月有1例、术后12、24、36个月各有2例症状反复,血管彩超及DSA造影检查提示均在原狭窄处又出现不同程度狭窄,4例行球囊扩张后缓解,3例植入支架后再通。结论髂股动脉介入治疗是一种安全有效的方法,成功率高,并发症少,再狭窄率低,可作为髂股动脉狭窄或闭塞的首选治方法。     

肾动脉狭窄患者治疗前后血浆肾上腺髓质素水平的变化

目的 探讨肾动脉狭窄患者在卡托普利抗高血压及介入支架治疗前后血浆肾上腺髓质素(ADM)水平的变化.方法 选取50例健康体检者作为对照组,66例肾动脉狭窄患者的血压按1999年WHO/ISH第4次修订的高血压诊断标准分为1、2、3级,36例肾动脉狭窄引起的继发性高血压患者接受了卡托普利治疗,其中27例治疗后血压降至正常,9例3级高血压患者治疗后血压降至2级,经接受介入支架治疗后血压降至正常;另30例接受了介入支架治疗,治疗后血压均降至正常,用放射免疫法测定对照组及各治疗组治疗前后血浆ADM浓度.结果 肾动脉狭窄患者血浆ADM浓度明显高于对照组,并且随着血压级别的升高,血浆ADM浓度也随之明显升高,在卡托普利及介入支架治疗后,血压及血浆ADM浓度明显下降.结论 肾动脉狭窄患者血浆ADM浓度明显升高,ADM在肾动脉狭窄引起的继发性高血压的病理生理过程中起一定作用,并且在卡托普利抗高血压及介入支架治疗后血压及ADM浓度明显下降,说明这两种治疗方法在肾动脉狭窄的治疗中及ADM对血压的调节和肾功能的保护有重要的意义.     

肝动脉支架置入术治疗原位肝移植术后肝动脉狭窄的远期疗效

目的 评估肝动脉支架置人治疗肝移植术后肝动脉狭窄的远期疗效.方法 2003年11月至2007年8月间,中山大学附属第三医院共26例确诊为肝移植术后肝动脉狭窄或闭塞患者,其中18例采用了同轴导管技术进行肝动脉支架置入术治疗.对所有患者的临床疗效及肝动脉通畅性进行评估.结果 支架置入术后2个月内有3个患者死亡,1例患者接受再移植.其余14例患者随诊时间均超过2个月.中位随诊时间为21.7个月(2.3～37.2个月).支架术后7例患者肝动脉保持通畅.4例(28.5%)患者出现肝动脉再狭窄.其中2例患者分别于术后5.1和20.5个月接受了再移植治疗.3例患者虽然肝动脉保持通畅,但仍分别死于多器官功能衰竭、肝脓肿和胆道感染.Kaplan-Meier曲线显示1、2和3年患者的生存率分别为76%、76%和76%,移植肝存活率分别为69.5%、69.5%和48.0%,原发性肝动脉通畅率分别为63%、63%和63%.结论 肝移植术后肝动脉狭窄可以采用支架置人成功进行治疗,可以获得令人满意的1、2和3年患者生存率、移植肝存活率和原发性肝动脉通畅率.     

Encephalopathy in renovascular hypertension associated with the use of oral contraceptives

Two female patients aged 19 years and 27 years presented with hypertensive encephalopathy and were subsequently found to have renal artery stenosis due to fibromuscular dysplasia. Both patients had had normal blood pressures recorded within the previous 6 months whilst taking the oral contraceptive pill. Their neurological state returned to normal with hypertensive control and in one case the hypertension was cured by dilatation of the renal artery stenosis by balloon angioplasty.     

儿童肾血管性高血压临床特点（附11例临床分析）

目的探讨儿童肾血管性高血压（RVH）的临床特点。方法回顾性分析11例RVH病儿的临床资料。结果多发性大动脉炎为RVH病儿的首要病因,占36．4％。首发症状以头痛、呕吐及抽搐多见。人院时平均收缩压和舒张压分别为21.9kPa与18．1kPa;高血压I期者4例,高血压Ⅱ期者7例。7例经数字减影血管造影确诊肾动脉狭窄,其中5例同时行多层螺旋CT血管造影,2例行磁共振血管造影,2种检查手段所示肾动脉狭窄部位、程度与DSA检查结果一致。7例卧位肾素、血管紧张素及醛固酮水平增高;5例病儿肾脏受累,5例超声心动图显示心脏受累,1例颅脑CT检查显示高血压性改变,3例眼底检查显示高血压性眼底改变。所有病儿均联合应用2种或2种以上降压药物,6例血压水平降至正常;5例病儿行外科治疗。结论多发性大动脉炎为儿童RVH主要病因,多种无创性影像学检查可联合应用于RVH的诊断,儿童RVH可存在多种靶器官受累,应定期检查。     

Effect of pregnancy on moderate renal failure in reflux nephropathy

During a 10 year study of women with reflux nephropathy 20 women had plasma creatinine concentrations in the range 0.2-0.4 mmol/l (2.3-4.5 mg/100 ml). Six experienced pregnancies exceeding 12 weeks' gestation. Pregnancy was associated with rapid deterioration in function in all six, resulting in end stage renal failure in four women within two years after delivery despite adequate control of blood pressure. Of the 14 women who did not have a prolonged pregnancy, four had periods of uncontrolled hypertension, all of which were related to non-compliance or loss from follow up, or both. Uncontrolled hypertension was also associated with accelerated renal failure, and all four women progressed quickly to end stage renal failure. The remaining 10 women were observed for from five to 10 years; in all 10 renal function deteriorated slowly, and none reached end stage renal failure within seven years. It is concluded that pregnancy in patients with reflux nephropathy and moderately severe renal failure has a deleterious effect on renal function.     

CYST DECAPITATING DECOMPRESSION OPERATION IN POLYCYSTIC KIDNEY PRELIMINARY REPORT OF 52 CASES

Decapitating decompression of polycystic kidney relieves local distension aching pain and renal hypertension satisfactorily, all 52 patients in this series being relieved of pain and the great majority with complicating hypertension having their blood pressure lowered. Some with bila- teral decompression had blood pressure con- trolled at normal for 7 t0 12 years. We believe that if the patients are properly selected, this operation relieves symptoms, delays progression of the polycystic condition and pro- longs life.     

Recent Advances in Hypertension

The possible relationship between the renal mechanism of volume control and blood pressure regulation is discussed. Expansion of the extracellular fluid (ECF) and plasma volumes was demonstrated following renal artery constriction in the rat; after about one month ECF volume returned to normal although hypertension persisted. Measurements of cardiac output in the unanesthetized rat by an implanted electromagnetic flowmeter showed an initial rise in cardiac output after renal artery constriction, returning to normal in 10 to 15 days. A homeostatic hypothesis for the production of renal hypertension is put forward in which changes in ECF volume, capacity vessel tone and myocardial contractility participate in the development of hypertension by elevating cardiac output. Autoregulation of peripheral flow then occurs and the consequent restoration of blood pressure at a renal pressure receptor results in return to normal of cardiac output by negative feedback. Thus in chronic hypertension the high peripheral resistance is maintained by autoregulation.     

The association of borderline hypertension with target organ changes and higher coronary risk. Tecumseh Blood Pressure study

The Tecumseh project investigates the evolution of hypertension in a healthy population. Of 946 subjects aged 18 through 38 years, 124 had clinic blood pressure readings higher than 140/90 mm Hg (the mean for borderline hypertensive subjects was 130/94 mm Hg). Compared with normotensive subjects, borderline hypertensive subjects had higher home blood pressures (mean, 12/7 mm Hg higher). Their childhood and postpubertal blood pressures were elevated (6/4 mm Hg higher than normal at age 6 years and 12/7 mm Hg higher than normal at age 21 years), and hypertensive target organ changes were detected. Borderline hypertensive subjects also had elevated minimal forearm resistance (0.22 U higher than normal), decreased stroke index (1.8 mL/m2 lower than normal), and impaired ventricular diastolic relaxation (mitral Doppler peak early diastolic blood flow [E] to peak late diastolic blood flow [A] ratio 0.13 lower than normal). Borderline hypertensive subjects had significant abnormalities in other coronary risk factors (cholesterol levels were 0.39 mmol/L higher, triglyceride levels were 0.45 mmol/L higher, high-density lipoprotein levels were 0.08 mmol/L lower, insulin levels were 38 pmol/L higher, and 16.5% more of them were overweight). Borderline hypertension is neither transient nor innocuous. Its association with other predictors of atherosclerosis calls for clinical attention.     

Malignant hypertension in women of childbearing age and its relation to the contraceptive pill

Eleven of 34 women aged 15-44 with malignant phase hypertension were taking oral contraceptives at presentation. All had had normal blood pressure before starting to take the pill. In four the interval between the start of oral contraception and the diagnosis of malignant hypertension was less than four months, and in eight no other cause for the hypertension was found. Underlying renal disease and renal failure were less common among pill users than among non-users with malignant hypertension who were of similar age. No pill user became normotensive after withdrawal of the pill, but blood pressure was well controlled (diastolic less than 90 mm Hg) in three patients taking only one drug. By contrast, all 23 non-users needed two or more antihypertensive drugs to control blood pressure. Ten year survival was 90% among pill users and 50% among non-users. These results suggest that oral contraceptives may be a common cause of malignant hypertension in women of child-bearing age. If the pill is stopped and underlying renal disease excluded the long term prognosis for such patients is excellent.     

后腹腔镜手术治疗腺瘤型原发性醛固酮增多症205例临床分析

对我院205例行后腹腔镜手术治疗的腺瘤型原发性醛固酮增多症患者的临床资料进行回顾性分析.所有病例术前均有高血压和低血钾病史.80例行肾上腺全切、125例行肾上腺部分切除术.手术时间15～150 min,平均（45±13）min.术中出血量10～200 ml,平均（25±10）ml.术后住院时间4～9 d,平均（6.8±1.2）d.随访6个月～2年,平均1.2年,所有病例血钾恢复正常,168例（82.0%）血压恢复正常.应用后腹腔镜行肾上腺全切除或部分切除治疗腺瘤型原发性醛固酮增多症,安全、有效.     

LUPUS NEPHRITIS COMPLICATED WITH MALIGNANT HYPERTENSION： FROM RENAL VASCULAR PATHOLOGY TO CLINICAL RELEVANCE

Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension. Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006. Results Of 19 patients, 3 were men and 16 were women, with a mean age of 24.4±7.7 years old. All had posi-tive antinuclear antibodies and low serum complement was found in 13 patients. All were anemic and 12 of them were thrombocytopenic. Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9μmol/L. Severe intrarenal arteriolar lesion was found in all patients. Six patients had lupus vasculopathy, 11 patients had renal thrombotic microangiopathy lesion, 2 had severe arteriosclerosis. All patients received steroids and immuno-suppressive drugs, 15 received angiotensin-converting enzyme inhibitor （ACEI）/angiotensin receptor blocker （ ARB ） with resultant well-controlled blood pressure. Thrombocytopenia and hemolytic anemia resolved remarkably. The renal function improved or recovered in 14 of 17 patients, and 3 developed end-stage renal disease on mainte-nance dialysis. Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension. Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type. On the basis of immunosuppressive drugs and steroids to control systemic lupus activity, timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.