移植肾动脉狭窄影响因素研究及介入治疗体会

Study on risk factors and interventional treatment of transplant renal artery stenosis

目的探讨移植肾动脉狭窄的发生因素及介入治疗体会。方法对16例移植肾动脉狭窄进行回顾性分析,其中11例作为介入组(狭窄程度≥50%),均行移植肾动脉支架植入术;5例移植肾动脉狭窄作为观察组(狭窄程度<50%),未行移植肾动脉支架植入术;9例作为对照组(为同一供肾),未发生移植肾动脉狭窄。观察介入组支架植入术前后血肌酐的变化,比较介入组与对照组、观察组的血肌酐和年龄差异。结果①介入组与对照组、观察组性别比例、发病时间无显著差异(P>0.05),但三组年龄有显著差异(P<0.05);②介入组11例患者中,移植肾动脉狭窄发生在吻合口狭窄1例,移植肾主干远端1例及近端9例,2例出现并发症,并发症率18.2%;③观察组5例患者血肌酐水平稳定,一年内平均水平为(120.32±2.38)μmol/l;介入组11例患者接受介入术后血肌酐水平显著下降,较术前差异有统计学意义(P<0.05);介入组术后血肌酐水平高于对照组与观察组,差异有统计学意义(P<0.05)。结论移植肾动脉狭窄的发生可能与手术操作因素相关,而且受者年龄可能是发生移植肾动脉狭窄的影响因素。对于严重狭窄者或伴肾功能血肌酐升高者,需行支架植入术,安全有效;而对于移植肾动脉轻度狭窄者可选择动态监测血肌酐。

Objective To investigate the risk factors and interventional treatment of transplant renal artery stenosis.Methods 16 cases of transplant renal artery stenosis were retrospectively analyzed,including 11 cases as intervention group(stenosis degree≥50%)with renal artery stent implantation,5 cases as observation group(stenosis degree<50%)without renal artery stent implantation.In addition,9 cases were selected as control group(the same donor kidney)without transplant renal artery stenosis.The changes of serum creatinine before and after stent implantation in intervention group were observed,and the differences of serum creatinine and age between intervention group,control group and observation group were compared.Results①There was no significant difference in sex ratio and onset time between intervention group and control group and observation group(P>0.05),but there was significant difference in age among three groups(P<0.05).②In the interventional group,1 case of transplant renal artery stenosis occurred in anastomotic stenosis,1 case in the distal end of the main renal graft and 9 cases in the proximal end of the main renal graft,2 cases had complications,the complication rate was 18.2%;③The serum creatinine level of 5 patients in the observation group was stable,with an average level of(120.32±2.38)μmol/L in one year;the serum creatinine level of 11 patients in the intervention group was significantly lower than that before intervention(P<0.05);the serum creatinine level in the intervention group was higher than that in the control group and the observation group,the difference was statistically significant(P<0.05).Conclusion The occurrence of transplant renal artery stenosis may be related to the operation factors,and the recipient's age may be the cause of renal artery stenosis.Stent implantation is safe and effective for patients with severe stenosis or with elevated serum creatinine,while dynamic monitoring of serum creatinine can be selected for patients with mild renal artery stenosis.