108例动脉硬化性肾动脉狭窄的腔内治疗临床分析

目的:评价经皮经腔肾动脉支架(PTRAS)治疗动脉硬化性肾动脉狭窄患者疗效。方法:对2006年3月至2010年3月应用肾动脉支架成形治疗动脉硬化性肾动脉狭窄108例患者回顾分析,探讨操作技术与并发症发生情况,随访观察患者血压改善情况及肾功能变化。结果:本组108例实施118支肾动脉支架成形技术,成功率100%,肾动脉狭窄段直径由术前(1.38±0.34)mm增至(5.65±0.78)mm,随访到93例(86.1%,93/108),随访时间3～45个月,平均随访(21.9±11.4)个月。术前收缩压平均(150.04±16.69)mmHg(1mmHg=0.133kPa),术后降至(137.05±12.58)mmHg,P0.001;术前舒张压平均(81.69±12.02)mmHg,术后降至(79.29±8.71)mmHg,P0.05。术前血肌酐(Crea)平均(91.63±38.06)umol/L,术后降至(87.69±40.31)umol/L,P0.001;术前尿素氮(Urea)平均(5.97±1.80)mmol/L,术后降至(5.63±1.83)mmol/L,P0.05。B超随访支架狭窄50%者占9.2%(7/76)。结论:肾动脉支架治疗严重动脉硬化性肾动脉狭窄创伤小、安全性高、可有效降低血压及维护肾功能水平,是严重肾动脉阻塞疾病的首选治疗方法。

Endovascular treatment of Arteriosclerosis renal artery stenosis:108 cases report

Objective：To evaluate the effect of percutaneous transluminal renal artery stent（PTRAS） treatment of patients with atherosclerotic renal artery stenosis.Methods：A retrospective analysis of 108 cases from March,2006 to March,2010 who recieved percutaneous transluminal renal artery stent for treating of atherosclerotic renal artery stenosis The operating techniques and complications were observed for improvements in blood pressure and renal function changing.Results：108 cases of the implementation of 118 renal artery stenting,the technical success rate is 100%.The renal artery diameter increased from（1.38 ± 0.34） mm preoperation to（5.65 ± 0.78） mm postoperation.93 patients（93 /108,86.1%） were followed up,The average follow-up time are（21.9 ± 11.4） months（3-45 months）.As a result,the Systolic pressure is observed decreased from an average of（150.04 ± 16.69） mmHg（1 mmHg = 0.133 kPa） to an average（137.05 ± 12.58） mmHg（P 0.001）.At the same time,the diastolic blood pressure from（81.69 ± 12.02） mmHg preoperation down to an average（79.29 ± 8.71） mmHg postoperation P 0.05.Serum creatinine from preoperative average of（91.63 ± 38.06） umol/L down to an average（87.69 ± 40.31） umol/L by follow up（P 0.001）,Urea from preoperative average of（5.97 ±1.80） mmol/L down to an average（5.63 ± 1.83） mmol/L（P 0.05）,ultrasonic examination showed that the restenosis rate（ 50%） is 9.2%（7 /76）.Conclusion：Percutaneous transluminal renal artery stent（PTRAS） is a mininvasive and safety method treating severe renal artery stenosis and can decrease blood pressure effectively maintaining the renal function,which is the first choice of treatment for renal artery stenosis.