腹膜后巨大畸胎瘤术后顽固性高血压一例及文献复习

目的 通过治疗腹膜后巨大畸胎瘤术后顽固性高血压及文献复习,提高对儿童肾血管性高血压的认识,探讨有效的治疗方案.方法 回顾性分析1例因腹膜后巨大畸胎瘤术后顽固性高血压,而在术后第9天再次手术切除左侧肾治疗高血压的临床资料.并通过检索中国知网(CNKI)、万方、维普数据库、Pubmed、Springer Link、Google Scholar等数据库和检索平台,对儿童肾血管高血压的中英文文献进行系统性综述,总结儿童肾血管性高血压的临床特点及诊治经验.结果 本例左侧肾切除术后恢复良好,病理证实为儿童肾血管性高血压,术后随访半年血压等各项指标均正常.共检索到符合纳入标准的患儿364例,其中2例先介入治疗效果差而后实施了肾切除;1例介入治疗后症状无缓解,而行肾动脉病变血管切除再吻合术,高血压症状才逐步缓解.术后随访6个月至12年不等,患儿血压均正常.结论 儿童肾血管性高血压为严重、药物难以控制的高血压,病因不同,治疗方法各异,除非其它治疗方法无效,切除肾需严格把握指征.

Surgical treatment of resistant hypertension after the operation of huge retroperitoneal teratoma: a case report and literature review

Objective To summarize the treatment strategies of resistant hypertension after operation of huge retroperitoneal teratoma and conduct a literature review to boost the awareness and management of pediatric renovascular hypertension.Methods The clinical data were collected for a 4-month-22-day-old child undergoing left side nephrectomy for resistant hypertension at Day 9 after operation of huge retroperitoneal teratoma.The clinical characteristics of pediatric renovascular hypertension were summarized and the experiences of diagnosis and treatment reviewed through both English and Chinese literature reports by searching the databases of Chinese Hownet (CNKI),Wanfang,Weipu,PubMed,SpringerLink and Google Scholar.Results The child had excellent postoperative recovery.The diagnosis of pediatric renovascular hypertension was pathologically confirmed.No hypertension recurred during a follow-up period of 6 months.A total of 364 cases of pediatric renovascular hypertension were retrieved.Two cases failed to respond to initial interventional therapy and underwent kidney excision.One case was not relieved.After anastomosing affected renal artery,the symptoms of hypertension gradually disappeared.During a postoperative follow-up period of 6 months to 12 years,all children were normotensive.Conclusions Pediatric renovascular hypertension is refractory to drug treatment.For different causes,treatment modalities vary.Resection of kidney should be the last resort when other treatments are ineffective.