肾动脉狭窄血管腔内治疗的临床研究

Follow-up study in endovascular therapy for the renal artery stenosis

目的评估肾动脉狭窄血管腔内治疗的安全性与疗效。方法33例肾动脉狭窄患者因严重高血压或伴有肾功能不全而进行了肾动脉经皮血管腔内成形和支架植入术(PTRAS),随访7～49个月,平均(24±2)个月,观察手术对患者血压、肾功能及病死率的影响。结果手术技术成功率为97.0%;2例(6.1%)术后4个月内死于心肌梗死;5例(15.2%)术前血清肌酐(Scr)≥177μmol/L,术后血压、Scr无明显改善,其中4例术后17～28个月死于尿毒症;总的病死率为18.2%。术前Scr<177μmol/L的患者,术后12、24个月,收缩压及舒张压明显下降,服用降压药物种类明显减少(P<0.05)。结论无严重心肾疾病的患者,PTRAS能明显降低血压,稳定肾功能,减少口服降压药种类,有较好的安全性和疗效;术前Scr≥177μmol/L的患者,术后病死率高,行PTRAS要慎重。肾保护装置可能对肾功能有保护作用。

Objective To evaluate the safety and efficacy of endovascular therapy for renal artery stenosis. Methods Percutaneous transluminal renal angioplasty with stent （PTRAS） was performed on 33 consecutive patients with severe renal artery stenosis who suffered from poorly controlled hypertension or renal dysfunction. They were subsequently underwent 7 to 49 months clinical follow up for the effect of the procedure on renal function, blood pressure control, mortality. Results Angiographic success was obtained in32（97.0%） of the 33 patients. The mortality was 18.2%. After PTRAS, two （6.1%） died of myocardial infarction within 4 months. Four （12.1%） patients with preoperative serum creatinine（Scr） ≥ 177 μmol/L died of uraemia within 17 - 28 months. Twelve and twenty-four months after the procedure, systolic and diastolic blood pressure of 26 （78.8%） cases with preoperative Scr 〈 177 μmol/L significantly decreased （P 〈 0. 05 ）, with less antihypertensive medications taken and satisfactory renal function. Conclusion For patients without serious cardiorenal disease, PTRAS has a beneficial effect on blood pressure and renal function. For patients with serious cardiorenal disease or preoperative Scr ≥ 177μmol/L, the mortality is higher. PTRAS should be performed prudently. The preservation of renal function may be enhance by using renal protection device.