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目的探讨肾动脉狭窄临床特点及经皮肾动脉成形术或支架植入术治疗效果。方法肾动脉狭窄患者65例中动脉粥样硬化型50例,大动脉炎型7例,肌纤维发育不良型8例;合并1~3级高血压或难治性高血压61例;均行经皮肾动脉成形术或经皮肾动脉支架植入术治疗。结果术中造影显示65例肾动脉狭窄程度达70~90(81.5±11.3)%,其中位于肾动脉开口处病变54例,肾动脉中段病变8例,肾动脉全段狭窄3例;59例顺利完成腔内治疗,其中行经皮肾动脉成形术13例,行经皮肾动脉支架植入术46例,余6例因肾动脉狭窄程度重,术中扩张狭窄段出现较强球囊扩张抵抗而未完成腔内治疗;术后患者血压((130.5±12.9)/(79.8±9.1)mm Hg)较术前((178.9±27.7)/(113.7±25.8)mm Hg)明显下降(t=15.307,P<0.01),高血压治疗有效率62.3%,术后肾功能改善率和稳定率分别达到9.4%和86.8%。结论肾动脉狭窄主要表现为难治性高血压,临床应针对不同病因采取不同腔内治疗方法。
Objective To investigate the clinical features of renal artery stenosis and the effect of percutaneous nephrectomy or stent implantation. Methods 65 cases of renal artery stenosis in 50 patients with atherosclerotic plaque, 7 cases of aortic arteritis, 8 cases of dysplasia; combined with 1 to 3 hypertension or refractory hypertension in 61 cases; percutaneous renal artery Plastic surgery or percutaneous renal artery stent implantation. Results The intraoperative angiography showed that the degree of stenosis of renal artery in 65 patients was 70-90 (81.5 ± 11.3)%, of which 54 were located in the opening of the renal artery, 8 were in the middle of the renal artery and 3 were in the whole segment of the renal artery. Complete endovascular treatment, of which 13 cases of percutaneous nephrectomy, percutaneous transluminal stent implantation in 46 cases, the remaining 6 cases of severe renal artery stenosis, intraoperative expansion of the stenosis appeared strong resistance to balloon dilatation (130.5 ± 12.9) / (79.8 ± 9.1) mm Hg decreased significantly compared with preoperative (178.9 ± 27.7) / (113.7 ± 25.8) mm Hg) (t = 15.307, P <0.01). The effective rate of hypertension treatment was 62.3%. The improvement rate and stability rate of renal function after operation reached 9.4% and 86.8% respectively. Conclusions Renal artery stenosis mainly presents as refractory hypertension, and different endovascular treatment methods should be taken for different etiologies.