炎性肾动脉狭窄的外科治疗分析:附31例报告

Analysis on Surgical Treatment in Patients with Inflammatory Renal Artery Stenosis:a Report of 31 Cases

目的:探讨炎性肾动脉狭窄的临床特点以及外科治疗方法的选择和疗效。方法:回顾分析1998年6月—2013年11月收治的31例行外科治疗的炎性肾动脉狭窄患者的临床资料。31例患者共接受外科治疗33例次,其中手术治疗17例次,包括腹主动脉肾动脉旁路术10例次,自体肾移植术5例次,肾切除2例次;腔内治疗16例次,包括球囊扩张术9例次(其中切割球囊术2例),支架成形术7例次(其中药物涂层支架1例)。结果;31例患者围手术期病死1例,其余30例患者中有23例获得随访,平均随访时间(41.8±35.7)个月,随访期内无病死病例。23例患者的随访显示,患者血压[(135.7±16.3)mmHg/(85.5±10.6)mmHg]较术前[(1 59.6±19.4)mmHg/(96.3±16.7)mmHg]显著下降(P<0.01);治愈3例,好转16例,降血压的有效率为82.6%;23例患者的血肌酐水平与术前比较差异无统计学意义。彩超随访显示,传统手术治疗的患者中有3例发生吻合口轻度再狭窄,而腔内治疗的患者中有4例发生中度再狭窄甚至闭塞。结论:炎性肾动脉狭窄多见于年轻患者,主要表现为顽固性高血压;外科治疗控制血压的效果确切,传统手术疗效优于腔内治疗。

Objective：To explore the clinical characteristics and the method and efficacy of surgical treatment of inflammatory renal artery stenosis.Methods：Clinical data of 31 cases with inflammatory renal artery stenosis who underwent surgical treatment from June 1998 to November 2013 was retrospectively analyzed.The 31 patients have undergone 33 times of surgical treatment.Among them,17 cases were surgical operations including 10 cases of abdominal aorto renal artery bypass,5 cases of renal autotransplantation,and 2 cases of nephrectomy; and the other 16 cases were endovascular treatment,including 9 cases of balloon angioplasty （including 2 cases of cutting balloon） and 7 cases of stent implantation （including 1 case of drug eluting stent）.Results：There was 1 perioperative death among the 31 cases.And 23 out of the other 30 cases have been followed up （mean 41.8 ± 35.7 months）.There was no death during the follow up period.There was a significant drop of blood pressure from [（135.7 ± 16.3）mmHg/（85.5 ± 10.6）mmHg] before the surgcial treatment to [（159.6 ± 19.4）mmHg/（96.3 ± 16.7） mmHg] after the surgical treatment（P〈0.01）,as the follow-up of the 23 cases showed.Totally 82.6% effective rate on blood pressure control was observed including 3 cured and 16 improved cases.There was no statistically significant difference in serum creatinine level before and after surgical treatment.According to color Doppler ultrasound follow-up,3 patients receiving conventional open surgery had mild anastomotic restenosis,while 4 patients undergoing endovascular treatment suffered moderate restenosis and even reocclusion.Conclusions：Inflammatory renal stenosis is most common in youth,with resistant hypertension as major presentation.Surgical treatment presents positive efficacy on hypertension control.The efficacy of conventional open surgery is superior to endovascular treatment.