经皮肾动脉成形术或支架植入术治疗肾动脉狭窄65例临床分析

Percutaneous transluminal balloon angioplasty or stenting for renal stenosis in 65 cases

目的探讨肾动脉狭窄临床特点及经皮肾动脉成形术或支架植入术治疗效果。方法肾动脉狭窄患者65例中动脉粥样硬化型50例，大动脉炎型7例，肌纤维发育不良型8例；合并1～3级高血压或难治性高血压61例；均行经皮肾动脉成形术或经皮。肾动脉支架植入术治疗。结果术中造影显示65例肾动脉狭窄程度达70～90（81．5±11．3）％，其中位于肾动脉开口处病变54例，肾动脉中段病变8例，肾动脉全段狭窄3例；59例顺利完成腔内治疗，其中行经皮肾动脉成形术13例，行经皮肾动脉支架植人术46例，余6例因。肾动脉狭窄程度重，术中扩张狭窄段出现较强球囊扩张抵抗而未完成腔内治疗；术后患者血压（（130．5士12．9）／（79．8±9．1）mmHg）较术前（（178．9±27．7）／（113．7±25．8）mmHg）明显下降（t=15．307，P〈0．01），高血压治疗有效率62．3％，术后肾功能改善率和稳定率分别达到9．4％和86．8％。结论肾动脉狭窄主要表现为难治性高血压，临床应针对不同病因采取不同腔内治疗方法。

Objective To investigate clinical features of renal stenosis and therapeutic effect of percutaneous transluminal balloon angioplasty or stenting. Methods In 65 cases of renal stenosis, there were 50 cases of atherosclerosis, 7 of Takayasu arteritis and 8 of fibromuscular dysplasia. Hypertension in grade I to Ⅲ or refractory hypertension was found in 61 cases. All cases were treated with percutaneous transIuminal balloon angioplasty （PBTA） or percutaneous transluminal renal artery stenting （PTRAS）. Results Intraoperative angiography showed 70 to 90 （81.5±11.3）% of renal artery stenosis in 65 cases, in which the stenosis segment in renal artery was located in the proximal, middle and whole renal artery in 54, 8 and 3 cases respectively. Fifty-nine cases were successfully performed endovasculartreatment, in which PTBA was performed in 13 cases and PTRAS in 46 cases. Six cases failed to fulfill endovascular treatment due to severe renal artery stenosis and resistance to balloon expansion. The blood pressure decreased from （178. 9±27. 7）/ （113.7±25.8） mm Hg before operation to （130.5±12.9）/（79.8±9.1） mm Hg after operation （t=15. 307, P〈0.01）, with the effective rate of 62.3%. The improvement rate and stable rate of postoperative renal function were 9.4% and 86.8%, respectively. Conclusions Renal artery stenosis is mainly manifested as refractory hypertension, and the patients should be given corresponding endovascular treatment based on different causes.