摘要
目的 评价经皮肾动脉腔内成形术 (PTRA)及支架术治疗肾动脉狭窄的可能性、安全性和疗效。方法 72例患者接受肾动脉造影后诊断肾动脉狭窄性疾病 ,造影同时或择期行PTRA和 (或 )支架术。观察术前、后血管直径和血流的变化 ,术中、术后并发症情况 ;术后门诊记录病情变化 ,包括临床症状、血压和肾功能 ,术后 6个月行肾动脉造影复查肾动脉再狭窄情况。高血压者术前、后应用相同的降压药物 ,肾功能变化通过血清肌酐值来评价。结果 血管造影示 72例中 6 0例为单侧血管病变 ,12例为双侧肾动脉病变 ,共 84处病变。病变狭窄程度为6 0 %～ 95 % ,平均狭窄程度为 (78 8± 10 3) %。狭窄位于肾血管开口部 76处 (占 90 4 % ) ,非开口部 6处 (占7 9% ) ,肾动脉分支血管 2处 (占 2 3% )。其中 ,6 8例接受支架术 ,共置入 78枚支架 ,单纯行PTRA 4例 ,手术即刻成功率 10 0 %。血管内径由术前平均 (1 7± 0 6 )mm(0 8～ 2 6mm)增至 (6 3± 1 4 )mm(4 0～ 8 0mm)。术前肾功能不全者 17例 ,术前、术后比较肾功能改善者达 70 6 %。该组高血压者 6 6例 ,血压好转或治愈率 6 5 2 %。围术期肾周围血肿 1例 ,股动脉拔管时出现迷走反射 3例 ,无围手术期死亡。结论 PTRA和 (或 )支架术是肾动脉狭窄的安全、有效治疗方?
Objective To assess the outcome of renal artery stenosis approached by percutaneous transluminal renal angioplasty (PTRA) and stents.Methods Seventy-two patients (50 males and 22 female) were diagnosed as renal stenosis by renal angiography.Of them,68 cases were with atherosclerosis.The PTRA was done via femoral access site.Changes in blood vessel diameter and blood flow nd complications were recorded.Renal angiograph was performed to check the restenosis.Patient’s blood pressure and serum creatine level before and after the were observed.Results Angiograph showed unilateral artery lesion in 60 cases and bilateral stenosis in 12 cases.The ostium was involved in 72 sites and mid-part in 8.The lumen diameter of stenosis was 60%-95%.The stents were successfully implanted in 68 cases with 78 stents and 4 cases only by balloon.The lumen diameter of lesion increased from 2.0mm (0.8-2.6mm) to 6.5mm (4.0-8.0mm).TIMI flow decreased in 3 cases and renal function was impaired in 4 cases,but not severe.Blood pressure in 42 cases with hypertension decreased significantly.One case was complicated with perirenal hematoma.and there was no perioperative death.Conclusion PTRA and stenting treatment for renal artery disease are feasible and safe.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2004年第1期19-21,共3页
Chinese Journal of Practical Internal Medicine
