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目的探讨经皮腔内肾动脉支架成形术(percutaneous transluminal renal artery stenting,PTRAS)治疗动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)的疗效。方法回顾分析2002年1月-2008年12月,采用PTRAS治疗69例ARAS患者的临床资料。男47例,女22例;年龄42～88岁,平均66.2岁。单侧66例,其中1例为单功能肾;双侧3例。肾动脉造影显示肾动脉狭窄程度为70%～99%。合并高血压67例,外周血管病损69例,冠心病34例,糖尿病44例,高血脂症36例。观察患者术后肾功能及血压变化并分析疗效。结果 1例肾动脉狭窄程度为99%的患者因急性夹层导致急性肾动脉闭塞,改行急诊旁路移植术;余68例均成功植入肾动脉支架,成功率为98.6%。68例肾动脉支架成功植入者中,1例术后3个月失访,1例术后6个月死于心肌梗死;余66例获随访,随访时间13～60个月,平均32个月。随访12个月时,血清肌酐水平为(107.8±35.4)μmol/L,与术前(104.1±33.8)μmol/L比较差异无统计学意义(P>0.05);9例肾功能改善(13.6%),48例稳定(72.8%),9例恶化(13.6%),肾功能获益率为86.4%。64例术前高血压患者随访12个月时,收缩压自术前(163±34)mm Hg(1mm Hg=0.133kPa)降至(132±24)mm Hg,舒张压自术前(89±17)mm Hg降至(78±11)mm Hg,差异均有统计学意义(P<0.05);4例高血压治愈(6.3%),52例改善(81.2%),8例失败(12.5%),高血压获益率为87.5%。随访12个月时2例(3.0%)出现再狭窄。结论 PTRAS治疗ARAS的手术成功率高,有助于高血压患者血压控制和稳定肾功能,远期疗效需进一步随访观察。
Objective To investigate the efficacy of percutaneous transluminal renal artery stenting (PTRAS) in the treatment of atherosclerotic renal artery stenosis (ARAS). Methods The clinical data of 69 ARAS patients treated with PTRAS from January 2002 to December 2008 were retrospectively analyzed. 47 males and 22 females; aged 42 to 88 years, mean 66.2 years old. 66 cases of unilateral, including 1 case of single-function kidney; bilateral in 3 cases. Renal angiography showed renal artery stenosis was 70% to 99%. 67 cases of hypertension, peripheral vascular lesions in 69 cases, coronary heart disease in 34 cases, 44 cases of diabetes, hyperlipidemia in 36 cases. Observe the postoperative renal function and blood pressure changes and analyze the curative effect. Results One patient with renal artery stenosis of 99% had acute renal artery occlusion due to acute dissection, and the emergency bypass graft was rerouted. The remaining 68 patients were successfully implanted with renal artery stent with a success rate of 98.6%. Of the 68 patients with renal artery stents who were successfully implanted, 1 patient was lost to follow-up 3 months after operation and 1 patient died of myocardial infarction 6 months after operation. The remaining 66 patients were followed up for 13 to 60 months with an average of 32 month. Serum creatinine level was (107.8 ± 35.4) μmol / L at 12 months of follow-up, with no significant difference from preoperative (104.1 ± 33.8) μmol / L (P> 0.05) ), 48 cases were stable (72.8%), 9 cases were deteriorated (13.6%), and the benefit rate of renal function was 86.4%. The systolic blood pressure decreased from (163 ± 34) mm Hg (1 mm Hg = 0.133 kPa) to (132 ± 24) mm Hg before surgery in 89 patients with preoperative hypertension at 12 months follow-up (P <0.05); 4 cases of hypertension cured (6.3%), 52 cases improved (81.2%), and 8 cases failed (12.5%). The difference was statistically significant ), Hypertension rate of 87.5%. Restenosis occurred in 2 patients (3.0%) at 12 months of follow-up. Conclusion The high success rate of ARTR surgery in PTRAS contributes to the control of blood pressure and the stabilization of renal function in patients with hypertension. The long-term efficacy needs further follow-up.