主动脉腔内修复术对B型主动脉夹层患者肾动脉血流及肾脏功能的影响

目的探讨主动脉腔内修复术对于B型主动脉夹层患者主动脉腔内修复术前、术后肾动脉血流及肾脏功能的影响。方法选择B型主动脉夹层患者110例,根据男性肾动脉受累类型不同分为ⅠA组(单侧或双侧肾动脉均为动力型缺血)10例、ⅠB组(单侧肾动脉为静力型缺血)36例、ⅠC组(双侧肾动脉为静力型缺血)8例;根据男性肾动脉受累数目分为双侧肾动脉未受累(未受累组)20例、单侧肾动脉受累(单侧受累组)38例、双侧肾动脉受累(双侧受累组)34例;根据女性肾动脉受累数目分为双侧肾动脉未受累(未受累组)8例、单侧肾动脉受累(单侧受累组)7例、双侧肾动脉受累(双侧受累组)3例。术前及术后观察双侧肾动脉的缺血情况及肾功能检查指标。并将各项指标进行对比。结果 220支肾动脉中动力型缺血共42支(19.1%);静力型缺血共80支(36.4%),主动脉腔内修复术后肾动脉动力型缺血全部得到显著改善,静力型缺血者可得到不同程度改善。随着肾动脉受累数量的增加,男性或者女性患者的肾功能受累情况呈进行性加重,且术后较术前呈下降趋势。结论对于B型主动脉夹层患者,主动脉腔内修复术能够开大主动脉真腔,提升肾动脉灌注,改善患者肾功能情况。

Effect of thoracic endovascular aortic repair on renal artery blood supply and renal function in type B aortic dissection patients

Objective To study the effect of thoracic endovascular aortic repair(TEVAR)on renal artery blood supply and renal function in type B aortic dissection patients.Methods One hundted and ten B type aortic dissection patients were divided intoⅠ A group(with dynamic ischemia of bilateral renal arteries,n=10),ⅠB group(with static ischemia of unilateral renal artery,n=36),ⅠC group(with static ischemia of bilateral renal arteries,n=34)according to the involved renal arteries in male patients,and intoⅡ A group(without involvement of bilateral renal arteries,n=20),ⅡB group(with involvement of unilateral renal artery,n=38),ⅡC group(with involvement of bilateral renal arteries,n=34)according to the involved renal arteries in female patients.Ischemia in bilateral renal arteries and renal function before and after operation were observed and compared.Results Of the 220 renal arteries,42(19.1%)had dynamic ischemia and 80(36.4%)had static ischemia.Both dynamic and static ischemia were improved after operation.The renal function progressively dcereased in male or female patients with the involvement of their renal arteries.Conclusion Thoracic endovascular aortic repair can enlarge the aortic lumen,improve the renal artery blood supply and renal function in type B aortic dissection patients.