实用器官移植电子杂志

实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (2): 106-109.DOI: 10.3969/j.issn.2095-5332.2020.02.007

• 论著 • 上一篇    下一篇

血管介入治疗移植肾动脉狭窄的疗效分析

李树欣 1，赵永恒 1，陈文忠 2，胡伟 1，周允冲 1，宋永琳 1，马寅锐 1，孙洵 1   

  1. 1. 昆明市第一人民医院泌尿外科，云南 昆明 650000 ； 2. 昆明市第一人民医院介入科，云南昆明 650000
  • 出版日期:2020-03-20 发布日期:2021-06-22

Analysis of the efficacy of vascular interventional therapy for transplanted renal artery stenosis  

Li Shuxin1，Zhao Yongheng1，Chen Wenzhong2，Hu Wei1，Zhou Yunchong1，Song Yonglin1，Ma Yinrui1，Sun Xun1.
  

  1. 1.Department of Urology，First People，s Hospital of Kunming，Kunming 650000，Yunnan，China ； 2.Department ofInterventional Radiology，First People，s Hospital of Kunming，Kunming 650000，Yunnan，China
  • Online:2020-03-20 Published:2021-06-22

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摘要：

目的 探讨血管介入治疗对移植肾动脉狭窄（transplanted renal arterial stenosis，TRAS）的 疗效。方法 回顾性分析本中心 513 例肾移植患者中并发 TRAS 的患者资料，比较血管介入治疗前、后的 1 周、1 个月、3 个月、6 个月，患者的肌酐、血压及移植肾血流动力学指标的变化。结果 513 例肾移植 患者中有 9 例并发 TRAS，发生率为 1.75%，9 例患者均行血管介入治疗，其中 8 例患者单纯行球囊扩张术， 1 例患者行球囊扩张后置入血管支架。8 例球囊扩张术的患者有 3 例术后 2 个月内再次出现狭窄，二次狭窄 率为 33.3%，再次给予球囊扩张均成功。所有患者随访 6 个月，1 例患者血管介入治疗后 4 个月因肺部感染 死亡。治疗前患者血肌酐为（142.3±59.6）μmol/L，治疗后 1 周、1 个月、3 个月、6 个月分别为（133.5± 57.2）μmol/L、（131.8±35.6）μmol/L、（127.0±29.9）μmol/L、（125.7±37.1）μmol/L，与术前相比，无统计学差异， 但有下降趋势。治疗前患者收缩压为（149.7±19.3）mmHg（1 mmHg ＝ 0.133 kPa），治疗后 1 周、1 个月、3 个月、 6 个月分别为（131.3±4.1）mmHg、（136.2±7.9）mmHg、（128.5±6.6）mmHg、（127.1±3.6）mmHg，与术前 相比，收缩压明显降低，具有统计学差异。治疗前患者移植肾主动脉峰值流速（peak systolic velocity，PSV） 为（297.2±105.3）cm/s，治疗后 1 周、1 个月、3 个月、6 个月分别（171±56.3）cm/s、（185.8±64.8）cm/s、 （197.5±69.1）cm/s、（178.8±75.4）cm/s，与术前相比，均具有统计学差异。治疗后 1 周、1 个月、3 个月、 6 个月的叶间 PSV、叶间动脉阻力指数，与术前相比，无统计学差异。结论 血管介入治疗的疗效确切，能有 效改善 TRAS 患者移植肾功能。

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Abstract:

Objective To investigate the effect of vascular interventional therapy on transplanted renal arterial stenosis（TRAS）. Methods The patients with concurrent TRAS among 513 patients with renal transplantation were retrospectively enrolled. The changes of creatinine，blood pressure and hemodynamic index of transplanted renal hemography in patients 1 week，1 month，3 months，and 6 months after treatment were compared. Results Of the 513 patients with kidney transplantation，9 experienced concurrent TRAS，with an incidence rate of 1.75%. The 9 patients were treated with vascular interventional treatment，8 patients received simple balloon expansion and 1 patient was implanted with vascular stents after balloon expansion. In patients with cystic dilation，3 cases recurred within 2 months of surgery，with a secondary stenosis rate of 33.3%，and the secondary cystic dilation was successful. All patients were followed up for 6 months，and one patient died of lung infection 4 months after vascular intervention therapy. Blood creatinine in pre-treatment patients was（142.3±59.6）μmol/L，and were （133.5±57.2）μmol/L，（131.8±35.6）μmol/L，（127.0±29.9）μmol/L，（125.7±37.1）μmol/L at 1 week，1 month， 3 months，6 months after treatment，respectively. Although there is no statistical difference，there is a downward trend after treatment. Pre-treatment systolic pressure was（149.7±19.3）mmHg（1 mmHg ＝ 0.133 kPa），the value were（131.3±4.1）mmHg，（136.2±7.9）mmHg，（128.5±6.6）mmHg，（127.1±3.6）mmHg at 1 week，1 month，3 months，6 months after treatment. Systolic pressure was significantly reduced compared with pre-treatment level. The Pre-treatment transplanted renal aortic peak systolic velocity（PSV）was（297.2±105.3）cm/s，the velocity were （171±56.3）cm/s，（185.8±64.8）cm/s，（197.5±69.1）cm/s，（178.8±75.4）cm/s at 1 week，1 month，3 months， 6 months after treatment, There are statistical differences compared with pre-treatment. The interfolate arterial PSV， interfolate artery resistance index were similar at 1 week，1 month，3 months，6 months after treatment compared to preoperative levels. Conclusion Vascular interventional therapy is effective in improving the transplanted kidney function of TRAS patients.

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