Marekovic Zvonimir, Mokos Ivica, Krhen Ivan, Goreta Nedjelka Ribicic, Roncevic Tomislav
Department of Urology and Internal Medicine (TR), University Hospital Center, Zagreb, Croatia.
J Urol. 2004 Mar;171(3):1043-5. doi: 10.1097/01.ju.0000110372.77926.c7.
At a time of minimally invasive surgery in urology, the role of surgical kidney revascularization in the management of renal artery disease has changed during the last decade. Our experience with surgical kidney revascularization, and the long-term clinical outcomes of fibromuscular dysplasia (FMD) and atherosclerotic renal artery stenosis are reviewed.
The study group comprised 140 patients with renovascular hypertension, 72 with FMD and 68 with atherosclerotic renal artery disease, who underwent surgical revascularization between 1982 and 1999. The indications for surgical revascularization were the treatment of hypertension and the preservation of renal function in 17 patients with renal artery occlusion, 55 with ostial stenosis, 52 with branch stenosis, 6 with bilateral artery stenosis, 7 with solitary kidney renal artery stenosis and 3 with solitary kidney renal artery occlusion.
Postoperative blood pressure and renal function were monitored for 1 to 17 years (mean 11.3). Long-term blood pressure control was observed in 93% of patients with FMD and in 71% of those with atherosclerosis. Improvement or stabilization of renal function was observed in 92% of patients with FMD and in 68% of those with atherosclerosis. The preoperative estimated glomerular filtration rate compared to postoperative was significantly increased in both groups.
Surgical kidney revascularization is effective in secondary hypertension with a high long-term efficacy in the normalization of blood pressure and in the preservation of renal function, especially in patients with a solitary or 1 functional kidney.
在泌尿外科微创手术时代，过去十年中手术性肾血管重建在肾动脉疾病管理中的作用发生了变化。我们回顾了手术性肾血管重建的经验以及纤维肌性发育不良（FMD）和动脉粥样硬化性肾动脉狭窄的长期临床结果。
研究组包括140例肾血管性高血压患者，其中72例患有FMD，68例患有动脉粥样硬化性肾动脉疾病，他们在1982年至1999年间接受了手术血管重建。手术血管重建的指征包括治疗高血压以及在17例肾动脉闭塞、55例开口狭窄、52例分支狭窄、6例双侧动脉狭窄、7例孤立肾肾动脉狭窄和3例孤立肾肾动脉闭塞患者中保留肾功能。
术后对血压和肾功能进行了1至17年（平均11.3年）的监测。FMD患者中93%和动脉粥样硬化患者中71%观察到长期血压得到控制。FMD患者中92%和动脉粥样硬化患者中68%观察到肾功能改善或稳定。两组术前估计肾小球滤过率与术后相比均显著增加。
手术性肾血管重建对继发性高血压有效，在血压正常化和保留肾功能方面具有较高的长期疗效，尤其是在孤立肾或单功能肾患者中。
