支架置入治疗30例肾动脉阻塞性疾病临床研究

The study of stent placement as treatment for renal artery obstructive disease

目的 评估分析支架成形术在治疗肾动脉阻塞性疾病方面的临床疗效。方法 本组患者 30例 ,均患有严重高血压或伴肾功能不全 ,造影证实有肾动脉阻塞性病变而后进行了支架置放术 (PTRAS)。病变血管共 38支 ,置入支架 34枚 ,选择支架以Palmaz及其新型支架为主 (2 8枚 )。术后观察病人血压及肾功能变化。结果 技术成功率 10 0 % (回弹率 <30 % ) ,未发生严重并发症。随访 6～ 15个月 (平均 10士 4个月 ) ,显示临床治愈 6例 (2 0 % ) ,改善 18例 (6 0 % ) ,无效 6例 (2 0 % ) ,临床总有效率 80 %。收缩压由术前平均 2 7.12± 3.0 9kPa降至术后随访平均18.6 2± 3.12kPa ,舒张压由术前平均 17.73± 1.92kPa降为术后平均 11.12± 2 .4 3kPa (P <0 .0 1) ,服用降压药物剂量或种类明显减少。术后血肌酐保持平稳者 2 7例 (90 % ) ,明显下降者 3例 (10 % )。结论 内支架成形术治疗肾动脉阻塞性疾病 ,临床疗效显著 。

Objectives: To evaluate the therapeutic results of expandable stent for treatment of renal artery obstructive disease. Materials and methods: Percutaneous transluminal renal angioplasty with stent(PTRAS) was performed on 30 consecutive patients with severe renal artery lesion for poorly controlled hypertension or preservation of renal function. The total number of the obstructive renal arteries was 38, and 34 stents were implanted under the guidance of flouroscapy. The most of stents implanted in lessions were Palmaz(n=28), Most of the patients Can be subsequently underwent clinical follow-up for the effect of the procedure on renal function, blood pressure control and the number of antihypertensive medications used. Results: Technical success (residual stenosis<30%) was achieved in all patients without serious complication. During the follow-up (6-15months, mean,10±4month), hypertension was improved in 18 patients, cured in 6 patients with a total benefit of 80% and no efficacy in 6(20%). The average systolic blood pressure decreased from 27.12±3.09kPa to 18.62±3.12kPa and the average diastolic blood pressure decreased from 17.73±1.92kPa to 11.12±2.43kPa after stent treatment(P<0.01) and less antihypertension medications were taken. Serum creatinine remained stable in 90%(n=27) patients, got improved in 10%(n=3) patients, There was no statistical significance in this respect. Conclusion: In this limited series, percutaneous transluminal stent placement was highly benefit for patients who had renal arterial obstructive disease. The procedure is safe in usual.