摘要
目的探讨儿童纤维肌性发育不良（FMD）所致的肾动脉分支病变的类型和腔内治疗的临床疗效。方法回顾性分析2014年6月至2015年12月河南省人民医院血管外科收治的8例FMD所致肾动脉分支病变患儿资料。常规行肾动脉CT血管造影（CTA）检查，明确肾动脉病变性质，并进一步行数字减影血管造影（DSA）明确诊断并分析病变特点。分析肾动脉分支病变类型及腔内治疗术后患儿血压、肾素水平、肾小球率过滤（GFR）、再狭窄等相关指标，并记录疾病转归。结果8例患儿中涉及二级分支6例，涉及三级分支2例；累及2条及以上分支动脉4例，累及1条分支动脉4例；伴有囊性扩张或动脉瘤5例，其中发生夹层动脉瘤伴有局部肾梗死患者1例，伴有动脉瘤且动脉瘤位于分支分叉处者1例；仅发生动脉狭窄3例。造影显示局灶性病变者5例，多灶性病变3例。1例出现动脉瘤伴夹层样改变，分支动脉涉及的肾脏组织发生肾梗死，患儿血压可以通过药物得以良好控制，未实施手术治疗。另7例患儿行腔内治疗术，手术成功率100%，无明显动脉夹层、破裂、栓塞等手术并发症。术后1周患儿血压明显改善，肾功能未见异常，肾素活性水平下降，GFR恢复。术后随访3～12个月，3例高血压好转，4例高血压治愈，所有患儿术后肾素水平及GFR好转，随访期间发生再狭窄2例再次手术，1年后所有患儿的狭窄部位血流通畅，无明显狭窄。结论FMD可引起肾动脉分支发生多样病变，应首选腔内治疗。
ObjectiveTo explore the lesion types of renal branches and evaluate the clinical results of endovascular treatment for renal artery branch lesions associated with fibromuscular dysplasia （FMD）.MethodsEight cases with renal artery branch lesions due to FMD from June 2014 to December 2015 in Department of Vascular and Endovascular Surgery, Henan Provincial People′s Hospital were retrospectively reviewed.The computed tomography angiography was routinely performed to ascertain the property of renal artery lesion, and digital-subtraction angiography was further performed to confirm FMD diagnosis and analyze lesion characteristics.The renal artery branch lesion types, blood pressure （BP）, renin activity, glomerular filtration rate （GFR） and restenosis after operation were observed, and the outcomes were recorded.ResultsIn 8 patients, 6 patients were found with the second grade renal branch lesions and 2 patients were found with tertiary branch lesions, involving 2 and more branch arteries for 4 cases and 1 branch for 4 cases.Five cases with branch-type cystic dilatation or aneurysms with coexisting stenosis including 1 case with dissecting aneurysm and renal local infarction, and 1 case with aneurysm located in the bifurcations of branches, and 3 cases with only branch stenosis were found.The angiography showed the small branch lesions of renal artery indicating FMD-mediated focal （5 cases） and multiple stenosis （3 cases）. The branch stenosis was not operated in 1 case with dissecting aneurysm and renal local infarction, as BP could be controlled by antihypertensive treatment.Other 7 cases underwent endovascular angioplasties and the technical successful rate was 100% without complications.After 1 week of operation, BP was improved, renal function remained normal, plasma renin activity was reduced and GFR was recovered for all patients.During the follow-up period （3 to 12 months）, BP improvement was observed in 3 cases, and cure were found in 4 cases, and patient′s GFR and plasma renin activ
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2017年第13期1026-1029,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
河南省医学科技攻关计划项目（201301011）
关键词
纤维肌性发育不良
肾动脉狭窄
肾动脉瘤
腔内治疗
Fibromuscular dysplasia
Renal artery stenosis
Renal artery aneurysm
Endovascular treatment
