经皮肾动脉支架植入治疗儿童肾动脉狭窄的疗效

Efficacy of Percutaneous Renal Artery Stenting in Treatment of Children with Renal Artery Stenosis

目的评价经皮肾动脉支架植入治疗儿童肾动脉狭窄的临床疗效。方法对2009年8月-2011年1月在本院行经皮肾动脉支架植入术的单侧肾动脉狭窄儿童患者25例进行随访,手术成功率100%,患儿年龄(129.3±18.9)个月,随访时间(9.2±1.9)个月,失访率为零。观察术前和随访结束时患儿血压、服药情况及血清肌酐(SCr)和胱抑素C(Cyst C)水平并进行统计学处理。结果 1.手术成功率为100%,共植入支架26枚,随访时间(9.2±1.9)个月。2.随访结束时收缩压[(18.992 4±1.6359)kPa vs(14.3374±1.8753)kPa,t=29.7,P<0.05]和舒张压[(11.132 1±2.021 6)kPa vs(9.695 7±1.782 2)kPa,t=30.3,P<0.05]较术前均有明显下降;血压的临床治愈率为84%(21/25例),4例仍服药,但服药种类由2.25种减少为1.50种。3.治疗前后血清SCr比较差异无统计学意义[(62.2±11.9)μmol·L-1vs(59.8±13.6)μmol·L-1,P>0.05],Cyst C治疗前后比较差异有统计学意义[(1.2±0.4)mg·L-1vs(0.9±0.3)mg·L-1,t=20.8,P<0.05]。结论经皮肾动脉支架植入治疗儿童肾动脉狭窄安全、有效,手术成功率高,有利于降低血压及改善肾功能。

Abstract： Objective To evaluate the clinical efficacy of renal artery stent implantation in children suffering from renal artery stenosis （RAS）. Methods Twenty - five children with unilateral RAS in the First Affiliated Hospital of Zhengzhou University from Aug. 2009 to Jan. 2011 were performed with pereutaneous renal artery stent implantation, the success rate of the operation was 100% , with the average age （ 129.3 ± 18.9 ） months, the average duration of follow - up was （ 9.2 ± 1.9 ） months, attrition rate was zero, they were investigated for blood pressure, different kinds or types of medications used and the levels of serum creatinine （SCr） and eystatin C （Cyst C ） and carried on statistics processing. Results 1. One hundred percent surgical success rate was observed for 26 implanted renal artery stents with the mean investiga- tion period of （9.2 ± 1.9） months. 2. A significant fall of blood pressure, both systolic and diastolic, compared with blood pressure recorded preoperatively,was observed at the end of investigation period [ （ 18. 992 4 ±1. 635 9 ） kPa vs （ 14. 337 4 ± 1. 875 3 ） kPa, （ 11. 132 1 ± 2. 021 6） kPa vs （9. 695 7 ± 1. 782 2） kPa,P 〈 0.05 ]. Clinical cure rate in blood pressure was 86% （21/25 cases） ,out of which 4 chil- dren were still taking antihypertensive drug, however, the amount （types） of medication used for the 4 children were remarkably reduced （ 1.50 to 2.25 ）. 3. No significant difference of Set level before and after treatment was observed [ （62.2 ±11.9 ） μmol · L-J vs （59.8 ± 13.6） μmol ·L-1 ,P 〉 0. 05 ] ,though a significant difference of Cyst C level was observed before and after treatment [ （ 1.2 ± 0. 4） mg · L -1 vs （ 0. 9 ± 0. 3 ） mg · L -1 ,P 〈 0. 05 ] Conclusions Percutaneous renal artery stent implant is safe and has high surgical success rate to treat RAS in children. It is equally effective in decreasing the elevated blood pressure in RAS affected children.