动脉粥样硬化性肾动脉狭窄外科治疗方法的选择及疗效评估

目的探讨动脉粥样硬化性肾动脉狭窄外科治疗方法的选择和疗效。方法回顾性分析1998年1月—2013年6月收治的80例经外科治疗的动脉粥样硬化性肾动脉狭窄的临床资料。结果本组男58例,女22例,年龄59~83岁。80例均有高血压、肾功能不全,经计算机断层X线血管造影、磁共振血管造影或数字减影血管造影确诊。全组共接受外科治疗83例次,其中支架成形73例次,球囊扩张6例次,腹主动脉肾动脉旁路3例次,肾动脉内膜切除1例次。80例均无围手术期死亡。随访67例,随访时间6~141个月,有3例发生远期死亡。随访患者血压为(140.3±14.4)/(78.1±8.3)mmHg,肌酐(130.7±65.2)μmol/L,与术前血压(152.5±18.3)/(83.1±9.3)mmHg与肌酐(145.8±90.3)μmol/L比较,差异有统计学意义(P0.05)。本组降压治疗有效率59.4%(38/64)。结论动脉粥样硬化性肾动脉狭窄通过外科治疗可有效改善血压和稳定肾功能,治疗方法首选腔内支架成形术。部分患者术后血压控制不佳主要原因可能是原发性高血压合并肾动脉狭窄。

Choice of Surgical Treatment and Evaluation of Curative Effect for Atherosclerotic Renal Artery Stenosis

Objective To explore the curative effect of surgical treatment for atheroscIerotic renal artery stenosis. Methods Clinical data of 80 patients with atherosclerotic renal artery stenosis undergone surgical treatment during January 1998 and June 2013 was retrospectively analyzed. Results There were 58 males and 22 females between 59-83 years old. All the 80 patients had high blood pressure and renal insufficiency, and were confirmed after examinations of CT angiography （CTA） , MR angiography （MRA） or digital subtraction angiography. A total of 83 surgeries were performed for all patients, and there were 73 stent implantations, 6 balloon angioplasties, 3 aorto-renal bypass surgeries and 1 renal endarterectomy. There was no fatality in preoperative period. A total of 67 patients were followed up for 6-141 months, including that long-term deaths occurred in 3 pa- tients. Levels of blood pressure and creatine in 67 patients were preoperative （152.5±18.3）/（83.1 ± 9.3）mmHg ＆ （145.8 ± 90.3 ）μmol/L and postoperative （ 140.3±14.4）/（78.1 ±8.3 ） mmHg ＆ （ 130.7± 65.2 ） μmol/L respectively, and the differ- ences were statistically significant （P 〈 0.05）. The effective rate of pressure release was 59.4% （38/64）. Conclusion Surgi- cal treatment of atherosclerotic renal artery stenosis can effectively improve hypertension and stabilize renal function, and endo- vascular stent implantation is the preferred choice of surgical treatment. Some patients＇blood pressure can not be controlled main- ly due to primary hypertension complicated by renal artery stenosis.