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目的评价经皮肾动脉支架植入治疗儿童肾动脉狭窄的临床疗效。方法对2009年8月-2011年1月在本院行经皮肾动脉支架植入术的单侧肾动脉狭窄儿童患者25例进行随访,手术成功率100%,患儿年龄(129.3±18.9)个月,随访时间(9.2±1.9)个月,失访率为零。观察术前和随访结束时患儿血压、服药情况及血清肌酐(SCr)和胱抑素C(Cyst C)水平并进行统计学处理。结果 1.手术成功率为100%,共植入支架26枚,随访时间(9.2±1.9)个月。2.随访结束时收缩压[(18.992 4±1.6359)kPa vs(14.3374±1.8753)kPa,t=29.7,P<0.05]和舒张压[(11.132 1±2.021 6)kPa vs(9.695 7±1.782 2)kPa,t=30.3,P<0.05]较术前均有明显下降;血压的临床治愈率为84%(21/25例),4例仍服药,但服药种类由2.25种减少为1.50种。3.治疗前后血清SCr比较差异无统计学意义[(62.2±11.9)μmol·L-1vs(59.8±13.6)μmol·L-1,P>0.05],Cyst C治疗前后比较差异有统计学意义[(1.2±0.4)mg·L-1vs(0.9±0.3)mg·L-1,t=20.8,P<0.05]。结论经皮肾动脉支架植入治疗儿童肾动脉狭窄安全、有效,手术成功率高,有利于降低血压及改善肾功能。
Objective To evaluate the clinical effect of percutaneous renal artery stent implantation on renal artery stenosis in children. Methods Twenty-five children with unilateral renal artery stenosis undergoing percutaneous nephrectomy in our hospital from August 2009 to January 2011 were followed up. The successful rate was 100%, and the mean age of children was (129.3 ± 18.9) Month, follow-up time (9.2 ± 1.9) months, the rate of loss to zero. The blood pressure, medication and serum creatinine (SCr) and cystatin C (Cyst C) levels in preoperative and postoperative follow-up were observed and statistically analyzed. Results 1. The success rate of surgery was 100%. A total of 26 stents were implanted. The follow-up time was 9.2 ± 1.9 months. The systolic blood pressure at the end of follow-up (18.992 4 ± 1.6359 kPa vs 14.3374 ± 1.8753 kPa, t = 29.7, P <0.05) and diastolic blood pressure (11.132 1 ± 2.021 6) kPa vs (9.695 7 ± 1.782 2 ) kPa, t = 30.3, P <0.05]. The clinical cure rate of blood pressure was 84% (21/25 cases), 4 cases were still taking the medication, but the dosage was reduced from 2.25 to 1.50. There was no significant difference in serum SCr before and after treatment [(62.2 ± 11.9) μmol·L-1vs (59.8 ± 13.6) μmol·L-1, P> 0.05], and the difference was statistically significant before and after treatment with Cyst C (1.2 ± 0.4) mg · L-1vs (0.9 ± 0.3) mg · L-1, t = 20.8, P <0.05]. Conclusion Percutaneous renal artery stent implantation is a safe and effective method for the treatment of renal artery stenosis in children. The success rate of operation is high, which is beneficial to lower blood pressure and improve renal function.