对比经皮腔内肾动脉球囊扩张成形术与支架植入术治疗移植肾动脉狭窄的有效性及安全性

Comparison on safety and efficacy of percutaneous transluminal renal artery balloon dilatation and stent angioplasty for treating transplanted renal artery stenosis

目的对比经皮腔内肾动脉球囊扩张成形术与经皮腔内肾动脉支架植入术治疗移植肾动脉狭窄(TRAS)的安全性及有效性。方法纳入39例接受腔内治疗的TRAS患者,根据治疗方式分为经皮腔内肾动脉球囊扩张成形术组(球囊组,n=21)及植入肾动脉支架组(支架组,n=18);比较组间治疗前、后的收缩压、舒张压、血肌酐、移植肾动脉峰值血流速度(PSV)及段间动脉阻力指数(RI)变化,以及并发症率、手术成功率和术后6个月一期通畅率。结果2组治疗成功率均为100%,并发症发生率差异无统计学意义(P>0.05)。治疗前及治疗后1、6个月,2组各指标差异均无统计学意义(P均>0.05)。治疗后1、6个月,2组血肌酐、PSV均较术前降低,RI均较术前升高(P均<0.05);治疗后6个月2组收缩压、舒张压均较术前及术后1个月降低(P均<0.05)。治疗后6个月支架组一期通畅率高于球囊组(94.44%vs.66.67%,P<0.05)。结论经皮腔内肾动脉球囊扩张成形术与经皮腔内肾动脉支架植入术治疗TRAS均安全、有效;相比前者,采用后者治疗后肾动脉再狭窄发生率更低。

Objective To compare the safety and efficacy of percutaneous transluminal renal artery balloon angioplasty and percutaneous transluminal renal artery stenting for treating transplanted renal artery stenosis(TRAS).Methods Thirty-nine TRAS patients were divided into percutaneous transluminal renal artery balloon angioplasty group(balloon group,n=21)or renal artery stent group(stent group,n=18)according to the management.Systolic and diastolic blood pressure,serum creatinine,graft artery peak systolic velocity(PSV)and resistance index(RI)before and after treatments were compared between groups,so as the incidence of complications,the success rate of treatments and the primary patency rate 6 months after treatments.Results The success rate of treatment was 100%in both groups,while no significant difference of complication incidence was found between groups(P>0.05).No significant difference of the above indexes was detected before nor 1 and 6 months after treatments between groups(all P>0.05).The serum creatinine and PSV was lower,and RI was higher in both groups 1 and 6 months after treatments than those before treatments(all P<0.05).The systolic and diastolic blood pressure 6 months after treatments were both lower than those before and 1 month after treatments(all P<0.05).The primary patency rate in stent group was higher than that in balloon group 6 months after treatments(94.44%vs.66.67%,P<0.05).Conclusion Both percutaneous transluminal renal artery balloon angioplasty and percutaneous transluminal renal artery stenting could be used to safely and efficiently treat TRAS.Compared with the former,the incidence of restenosis could be reduced by using the latter.