裸支架置入治疗移植肾动脉狭窄的近期疗效

doi:10.3877/cma.j.issn.2095-5782.2017.02.004

中华介入放射学电子杂志 ›› 2017, Vol. 05 ›› Issue (02) : 74 -78. doi: 10.3877/cma.j.issn.2095-5782.2017.02.004

所属专题：文献；

血管介入

裸支架置入治疗移植肾动脉狭窄的近期疗效

李新玲¹, 刘欢¹, 郝珂楠¹, 肖利军¹, 庞桦进¹, 李思慎¹, 叶耀超¹, 何晓峰¹^,^†(

)

^1. 510515　广州，南方医科大学南方医院介入科

收稿日期:2017-02-10 出版日期:2017-05-01
通信作者: 何晓峰

Short-term efficacy of bare stent placement in the treatment of transplant renal artery stenosis

Xinling Li¹, Huan Liu¹, Kenan Hao¹, Lijun Xiao¹, Huajin Pang¹, Sishen Li¹, Yaochao Ye¹, Xiaofeng He¹^,^†()

^1. Department of Interventional Radiology, Southern Medical University, Nanfang Hospital, Guangzhou 510515, China

Received:2017-02-10 Published:2017-05-01
Corresponding author: Xiaofeng He
About author:
Corresponding author: He Xiaofeng, Email: ozonetherapy@126.com

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目的：

探讨裸支架置入治疗移植肾动脉狭窄（TRAS）的近期疗效。

方法：

回顾性分析2014年4月—2016年6月我科收治的28例TRAS患者的临床资料，经综合评估后均行移植肾动脉裸支架置入术。比较支架置入术前和术后7 d的尿量，术前与术后1、3、6个月的收缩压、舒张压、降压药物用量、血清肌酐水平、肾小球滤过率（eGFR）之间的差异。

结果：

28例患者术前及术后7 d尿量相比，差异有统计学意义（P<0.01）。裸支架置入术后1、3、6个月，患者收缩压、舒张压、血清肌酐水平、eGFR与术前相比均有改善，差异有统计学意义（P<0.05）。技术成功率100%，术后1、3、6个月支架通畅率分别为100%（28/28）、96.43%（27/28）、100%（28/28）。6个月随访临床成功率为96.43%（27/28），1例裸支架置入术后出现移植物慢性排斥反应；1例于术后3个月出现移植肾动脉再狭窄，经支架内球囊扩张后明显改善。

结论：

裸支架置入治疗TRAS是一种安全、有效的方法，且具有较好的近期疗效。

关键词: 移植肾动脉狭窄, 裸支架置入, 近期疗效

Objective:

To explore the short-term efficacy of bare stent placement in the treatment of transplant renal artery stenosis (TRAS).

Methods:

Clinical data of 28 patients with TRAS who were treated in our department between April 2014 and June 2016 were retrospectively analyzed. All patients underwent transplant renal artery bare stent placement after a comprehensive evaluation. The urine volumes before and 7 days after the intervention, systolic blood pressure, diastolic blood pressure, antihypertensive drug dosage, and serum creatinine levels and eGFR before and 1, 3, 6 months after the intervention were compared and analyzed.

Results:

There were significant differences (P <0.01) between the preoperative urine volume and 7 days after intervention. The systolic blood pressure, diastolic blood pressure, serum creatinine levels and eGFR were improved compared to those before the intervention, and the differences were statistically significant (P <0.05). Technical success rate was 100%. Stent patency rates at 1, 3, 6 months after the intervention were 100%, 96.43%, 100%, respectively. Clinical success rate was 96.43% at 6 month, and the chronic rejection of the graft was found in 1 case of bare stent placement. 1 case occurred transplant renal artery restenosis 3 months later, which was significantly improved after balloon expansion.

Conclusion:

Bare stent placement is a safe and effective strategy in the treatment of TRAS with satisfied short-term efficacy.

Key words: Transplant renal artery stenosis, Bare stent placement, Short-term efficacy

图1 移植肾动脉狭窄分型

图2 40岁女性患者，肾移植术后3个月发生移植肾动脉狭窄，对侧穿刺造影示：移植肾动脉主干狭窄（2A），狭窄率达56%（2B），移植肾动脉主干与右侧髂外动脉近段成角为向上锐角，由同侧股动脉引入支架定位并释放（2C），术后复查造影支架内血流通畅（2D），术后6个月超声示支架内血流通畅（2E）

表1 TRAS患者裸支架置入术前后临床指标比较（n=28, ±s）

时间	收缩压（mmHg）	舒张压（mmHg）	血肌酐（μmol/L）	eGFR（ml/min·1.73m²）
术前	152.46±16.14	87.36±11.99	246.57±199.34	39.81±16.86
术后1个月	135.14±11.40^a	82.82±8.23^a	154.43±59.10^a	60.21±21.87^a
术后3个月	131.00±9.21^a	82.07±6.57^a	138.71±57.10^ab	66.83±19.85^ab
术后6个月	130.10±6.55^a	78.00±6.61^a	130.43±61.40^abc	73.58±24.09^abc
F值	23.299	5.515	6.407	13.729
P值	<0.05	<0.05	<0.05	<0.05

表1 TRAS患者裸支架置入术前后临床指标比较（n=28, ±s）

时间	收缩压（mmHg）	舒张压（mmHg）	血肌酐（μmol/L）	eGFR（ml/min·1.73m²）
术前	152.46±16.14	87.36±11.99	246.57±199.34	39.81±16.86
术后1个月	135.14±11.40^a	82.82±8.23^a	154.43±59.10^a	60.21±21.87^a
术后3个月	131.00±9.21^a	82.07±6.57^a	138.71±57.10^ab	66.83±19.85^ab
术后6个月	130.10±6.55^a	78.00±6.61^a	130.43±61.40^abc	73.58±24.09^abc
F值	23.299	5.515	6.407	13.729
P值	<0.05	<0.05	<0.05	<0.05

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