彩色多普勒超声在肾动脉狭窄支架植入术前后的应用价值

Color Doppler flow imaging before and after percutaneous transluminal angioplasty stenting for renal artery stenosis

目的评价彩色多普勒超声在肾动脉狭窄患者行支架植入术（PTAS）前、后的应用价值。方法对比分析32例肾动脉狭窄患者（其中5例为双侧肾动脉狭窄）在PTAS介入治疗前及术后1周肾动脉峰值流速（PSV）、肾动脉与腹主动脉峰值流速比值（RAR）、肾动脉与叶间动脉峰值流速比值（RIR），并与正常肾动脉组（60例）进行对照。结果PTAS术前肾动脉狭窄处内径（0．2±0．1）cm，术后肾动脉支架内径（0．4±0．1）cm；术前狭窄处PSV（314±123）cm／s，术后支架内PSV（121±76）cm／s；术前RAR3．3±1．5，术后RAR1．3±0．7；术前RIR7．8±4．1，术后RIR2．8±2．1；术前Cr（90．8±23．9）μmol／L，术后Cr（94．2±22．9）mol／L；术前BUN（6．9±2．2）mmol／L，术后BUN（6．0±1．6）mmoL／L。正常对照组肾动脉起始段PSV（92±29）cm／s；RAR1．3±0．4；RIR2．3±0．8。PTAS术后肾动脉起始段及肾内血流灌注均得到明显改善，支架内PSV均无明显升高，术后RAR、RIR均恢复正常，但是术后肾功能较术前无明显改善。结论彩色多普勒超声是对肾动脉狭窄介入治疗前筛选诊断及支架植入后疗效评价的一种无创、简便可靠的检查方法。

Objective To evaluate the diagnostic value of color Doppler flow imaging （CDFI） in the renal artery stenosis percutaneous transluminal angioplasty stenting （PTAS）. Methods A comparative analysis of the 32 cases （5 cases with bilateral renal artery stent） with renal artery stenosis in renal arterypeak systolic velocity（PSV）, renal aortic ratio（RAR） and renal-interlobar ratio（RIR） before and a week after the PTAS, and compared with normal renal artery group（60 cases）. Results PTAS preoperative renal artery residual cavity inside （0.24 ＋ 0.07） cm, postoperative renal artery stent inner diameter （0.4 ＋ 0. 1 ）cm; Preoperative stenosis at PSV （313 ＋ 123 ）cm/s, postoperative （ 121 ＋ 76） cm/s ; RAR preoperative 3.3 ＋ 1.5, postoperative 1.3 ＋ 0.7 ; RIR preoperative 7.8 ＋ 4. 1, postoperative 2.8 ~ 2.1 ; Cr preoperative （90.8 ＋ 23.9） p^mol/L, postoperative （94.2 ~ 22.9 ） p^mol/L; BUN preop- erative （6.9 ~ 2.2） mmol/L, postoperative （ 6.0 ＋ 1.6） mmol/L. Renal artery normal controlgroup SV （ 92.3 ~ 28.6） cm/s ; RAR 1.3 ~ 0.4 ; RIR 2.3 ~ 0.8. Start of renal artery and renal blood perfusion in all were significantly improved, stent PSV had no obvious rise, postoperative RAR, RIR were back to normal after the PTAS. Conclusion Color doppler flow imaging is a noninvasive, convenient and reliable inspection method in evaluating renal artery stenosis PTAS.