肾动脉狭窄80例外科治疗

目的 探讨肾动脉狭窄外科治疗方法的选择和疗效.方法 回顾性分析1997年11月到2008年8月80例肾动脉狭窄患者的外科治疗经验.男性53例,女性27例,年龄9～80岁.病变包括动脉硬化42例,大动脉炎23例,肌纤维发育不良11例.共接受外科治疗83人次,其中腹主动脉肾动脉旁路术13例,自体肾移植术5例,肾切除术1例,肾动脉内膜切除术1例,肾动脉狭窄段切除吻合术1例,球囊扩张术14例,支架成形术48例.结果 围手术期死亡1例.63例获得随访,随访时间1～129个月,2例死亡.随访患者血压(135.7±15.8)/(80.1±8.5)mm Hg(1 mm Hg=0.133kPa),较术前(149.8±18.3)/(88±13.6)mm Hg下降(P<0.01).总的降压有效率为65.6%,动脉硬化、大动脉炎、肌纤维发育不良患者的降压有效率分别为50%、73.3%和100%(P<0.05).随访患者肌酐(112.7±53.6)/μmol/L,低于术前(131.7±91.7)μmol/L(P<0.05).结论 肾动脉狭窄通过外科治疗可以有效改善血压和肾功能,动脉硬化病变首选支架成形,肌纤维发育不良性病变首选球囊扩张,大动脉炎性病变首选手术治疗.

Surgical treatment of renal stenosis: a report of 80 cases

Objective To evaluate the curative effect of surgical treatment for renal stenosis.Methods Eighty cases from November 1997 to August 2008 were reviewed,including 53 males and 27females,aged from 9 to 80 years old.There are 42 atherosclerosis,23 Takayasu arteritis and 11fibrodysplasia patients.Surgical procedures included aorto-renal bypass for 13 cases,autogenous renal transplantation for 5 cases,nephrectomy for 1 case,renal endarectomy for 1 case,lesion resection and reconstruction for 1 case,balloon angioplasty for 14 cases,and stent implantation 48 cases.Results There were 1 mortality peri-operation.During follow-up (1 to 129 months),2 among 63 patients died.Significant decline of blood pressure (135.7±15.8)/(80.1±8.5) mm Hg (1 mm Hg=0.133 kPa) vs.(149.8±18.3)/(88±13.6) mm Hg,P <0.01]and totally 65.6% effective rate were observed.Atherosclerosis,Takayasu arteritis and fibrodysplasia group all presented positive anti-hypertension results with 50%,73.3%and 100% effective rate respectively (P<0.05).The creatine level also underwent significant decrease (112.7±53.6) μmol/L vs.(131.7±91.7) μmol/L,P <0.05],mainly in atherosclerosis group (127.2±56.6) μmol/L vs.(138.0±87.0) μmol/L,P<0.05].Conclusions Surgical treatment of renal stenosis can achieve improvement in hypertension and renal function.Endovascular stent and angioplasty are the first choices for atherosclerotic and fibrodysplasia patients respectively,while open surgery is better for Takayasu arteritis ones.