经皮腔内肾动脉支架成形术治疗动脉粥样硬化性肾动脉狭窄的疗效分析

EFFECTIVENESS OF PERCUTANEOUS TRANSLUMINAL RENAL ARTERY STENTING IN TREATING ATHEROSCLEROTIC RENAL ARTERY STENOSIS

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 effectiveness of percutaneous transluminal renal artery stenting （PTRAS） in treating atherosclerotic renal artery stenosis （ARAS）. Methods A total of 69 patients with severe ARAS were treated with PTRAS between January 2002 and December 2008. There were 47 males and 22 females with an average age of 66.2 years （range, 42-88 years）, including 66 cases of unilateral ARAS （single functional kidney, 1 case） and 3 cases of bilateral ARAS. Renal angiography revealed that the degree of renal artery stenosis was 70%-99%. Concomitant diseases included hypertension （67 cases）, atherosclerosis obliterans （69 cases）, coronary heart disease （34 cases）, diabetes （44 cases）, and hyperlipidemia （36 cases）. Blood pressure, serum creatinine （sCr）, and patency of the renal artery were measured to assess the effectiveness of PTRAS after 12 months. Results The renal artery stent was successfully implanted in 68 patients and the technical success rate was 98.6%. One patient was converted to ilio-renal bypass because of intra-operative acute renal artery occlusion. One patient died of heart failure at 6 months after PTRAS, and 1 patient was lost at 3 months after PTRAS. The other 66 patients were followed up 32 months on average （range, 13-60 months）. The blood pressure decreased significantly at 1 month and gained a further decrease at 12 months after PTRAS when compared with the preoperative ones [systolic blood pressure： （132 ± 24） mm Hg vs （163 ± 34） mm Hg, P〈0.05; diastolic blood pressure： （78 ± 11） mm Hg vs （89 ± 17） mm Hg, P〈0.05; 1 mm Hg=0.133 kPa]. Hypertension was cured in 4 cases （6.3%）, improved in 52 cases （81.2%）, failure in 8 cases （12.5%）, and the overall benefit rate was 87.5%. The sCr level was stable after 12 months of PTRAS, showing no significant difference when compared with preoperative baseline [（107.8 ± 35.4） μmol/L vs （104.1 ± 33.8） μmol/L, P〈0.05]. Renal function was improved in 9 cases （13.6%）, stable in 48 cases （72.8%）, deterioration in 9 cases （13.6%）, and the overall benefit rate was 86.4%. Instent restenosis found in 2 patients （3.0%） at 12 months after operation. Conclusion PTRAS is a safe and effective method to treat ARAS. It can control the blood pressure and stabilize the renal function in most ARAS patients. Long-term efficacy needs further investigation.