肌纤维发育不良所致肾动脉狭窄16例的治疗
기섬유발육불량소치신동맥협착16례적치료
Renal stenosis resulting from fibromuscular dysplasia and its surgical treatment: report of 16 cases
  • 万方数据
    中华普通外科杂志 중화보통외과잡지
    CHINESE JOURNAL OF GENERAL SURGERY
    2012年 10期 786-788 ,共3页

    史振宇%符伟国%郭大乔%陈斌%徐欣%蒋俊豪%杨珏%竺挺%董智慧%石赟%王利新%唐骁%王玉琦

    사진우%부위국%곽대교%진빈%서흔%장준호%양각%축정%동지혜%석빈%왕리신%당효%왕옥기

    肾动脉梗阻%血管成形术,气囊%高血压,肾性%肌纤维发育不良 腎動脈梗阻%血管成形術,氣囊%高血壓,腎性%肌纖維髮育不良
    신동맥경조%혈관성형술,기낭%고혈압,신성%기섬유발육불량
    Renal artery obstruction%Angioplasty,balloon%Hypertension,renal%Fibromuscular dysplasia
    目的 探讨肌纤维发育不良所致的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 回顾性分析1998- 2011年收治的16例(17处病变)肌纤维发育不良所致的肾动脉狭窄的临床资料.16例患者平均年龄(28±13)岁,其中患高血压16例次,肾功能不全1例次.16例患者共接受外科治疗17次,其中腹主动脉-肾动脉旁路术2例；肾动脉狭窄段切除吻合2例；球囊扩张10例次；支架成形3例次.结果 16例患者围手术期死亡1例；余15例患者13例获得随访,随访时间6～149个月,平均(41±38)个月.无死亡病例.平均血压(134±14)/(83 ±8) mm Hg较术前(151 ±17)/(96±16)mm Hg有显著下降(P＜0.01),其中治愈5例,好转8例,降压有效率为100％.患者肌酐水平(69 ±22) μmol/L,与术前(61±22)μmol/L比较,差异无统计学意义(P＞0.05),其中改善4例,稳定9例.复查彩超12例患者只有1例再狭窄.结论 肌纤维发育不良所致的肾动脉狭窄多见于儿童和年轻患者,首要表现是顽固性高血压.球囊扩张为首选治疗,降压效果肯定.
    목적 탐토기섬유발육불량소치적신동맥협착적림상특점이급외과치료방법적선택화료효.방법 회고성분석1998- 2011년수치적16례(17처병변)기섬유발육불량소치적신동맥협착적림상자료.16례환자평균년령(28±13)세,기중환고혈압16례차,신공능불전1례차.16례환자공접수외과치료17차,기중복주동맥-신동맥방로술2례；신동맥협착단절제문합2례；구낭확장10례차；지가성형3례차.결과 16례환자위수술기사망1례；여15례환자13례획득수방,수방시간6～149개월,평균(41±38)개월.무사망병례.평균혈압(134±14)/(83 ±8) mm Hg교술전(151 ±17)/(96±16)mm Hg유현저하강(P＜0.01),기중치유5례,호전8례,강압유효솔위100％.환자기항수평(69 ±22) μmol/L,여술전(61±22)μmol/L비교,차이무통계학의의(P＞0.05),기중개선4례,은정9례.복사채초12례환자지유1례재협착.결론 기섬유발육불량소치적신동맥협착다견우인동화년경환자,수요표현시완고성고혈압.구낭확장위수선치료,강압효과긍정.
    Objective To evaluate the clinical characteristics and surgical treatment of renal stenosis resulting from fibromuscular dysplasia ( FMD ). Methods 16 cases from 1998 to 2011 were reviewed,the average age was (28 ± 13 ) years old. Among them, all patients suffered refractory hypertension and only one presented renal dysfunction. Aorto-renal bypass was performed in 2 cases.Resection and reconstruction was performed in 2 cases,balloon angioplasty in 10 and stent implantation in 3.Results There was 1 death peri-operatively.13 out of 15 cases were followed-up with no death.Significant decline of blood pressure [ (134 ± 14 )/( 83 ± 8 ) mm Hg vs.( 151 ± 17 )/( 96 ± 16 ) mm H g ( P ＜ 0.01 ) ]and 100％ effective rate were observed.The creatine level were preserved after surgical treatment [ (61 ±22) μmol/L vs.(69 ± 22) μmol/L,(P ＞ 0.05 ) ] with 4 cases improved and the other 9 stable.12 patients received ultrasound surveillance with only one case of 20％ restenosis. Conclusions Renal stenosis due to FMD are most common in children and the youth with hypertension as major presentation. Balloon angioplasty is the first choice of surgical treatment with positive efficacy.
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