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目的 评价经皮肾动脉腔内成形术 (PTRA)及支架术治疗肾动脉狭窄的可能性、安全性和疗效。方法 72例患者接受肾动脉造影后诊断肾动脉狭窄性疾病 ,造影同时或择期行PTRA和 (或 )支架术。观察术前、后血管直径和血流的变化 ,术中、术后并发症情况 ;术后门诊记录病情变化 ,包括临床症状、血压和肾功能 ,术后 6个月行肾动脉造影复查肾动脉再狭窄情况。高血压者术前、后应用相同的降压药物 ,肾功能变化通过血清肌酐值来评价。结果 血管造影示 72例中 6 0例为单侧血管病变 ,12例为双侧肾动脉病变 ,共 84处病变。病变狭窄程度为6 0 %～ 95 % ,平均狭窄程度为 (78 8± 10 3) %。狭窄位于肾血管开口部 76处 (占 90 4 % ) ,非开口部 6处 (占7 9% ) ,肾动脉分支血管 2处 (占 2 3% )。其中 ,6 8例接受支架术 ,共置入 78枚支架 ,单纯行PTRA 4例 ,手术即刻成功率 10 0 %。血管内径由术前平均 (1 7± 0 6 )mm(0 8～ 2 6mm)增至 (6 3± 1 4 )mm(4 0～ 8 0mm)。术前肾功能不全者 17例 ,术前、术后比较肾功能改善者达 70 6 %。该组高血压者 6 6例 ,血压好转或治愈率 6 5 2 %。围术期肾周围血肿 1例 ,股动脉拔管时出现迷走反射 3例 ,无围手术期死亡。结论 PTRA和 (或 )支架术是肾动脉狭窄的安全、有效治疗方?
Objective To evaluate the feasibility, safety and efficacy of percutaneous transluminal renal angioplasty (PTRA) and stenting in the treatment of renal artery stenosis. Methods 72 patients underwent renal artery angiography diagnosis of renal artery stenosis, angiography at the same time or elective PTRA and (or) stenting. The changes of blood vessel diameter and blood flow before and after the operation were observed. The intraoperative and postoperative complications were observed. The postoperative outpatient records of the disease were changed, including clinical symptoms, blood pressure and renal function. Renal arterial angiography Restenosis. Hypertensive patients with the same antihypertensive drugs before and after surgery, renal function changes by serum creatinine value to evaluate. Results angiography showed 72 cases of 60 cases of unilateral vascular disease, 12 cases of bilateral renal artery disease, a total of 84 lesions. The degree of stenosis was 60% -95% and the average stenosis was (78 8 ± 10 3)%. The stenosis was located in 76 (90.4%) of the openings of the renal vessels, 6 (7-9%) of the non-openings and 2 (23%) of the branches of the renal arteries. Among them, 68 cases underwent stenting, and 78 stents were implanted. Only 4 cases were treated with PTRA. The success rate was 100% immediately. The mean internal diameter of the vessels increased from (17 ± 0 6) mm (0 8 ~ 26 mm) to (6 3 ± 1 4) mm (40 ~ 80 mm). Preoperative renal insufficiency in 17 cases, preoperative and postoperative improved renal function compared to 70 6%. The group of hypertensive patients 6 6 cases, blood pressure improvement or cure rate of 652%. Perioperative renal hematoma in 1 case, femoral artery extubation vagal reflex in 3 cases, no perioperative death. Conclusion PTRA and / or stenting is a safe and effective treatment for renal artery stenosis.