Weibull H, Bergqvist D, Jendteg S, Lindgren B, Persson U, Jonsson K, Bergentz S E
Department of Surgery, Malmö General Hospital, Lund University, Sweden.
Br J Surg. 1991 May;78(5):620-4. doi: 10.1002/bjs.1800780531.
Clinical outcome and health care costs related to investigation, treatment with either percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery, and follow-up of patients with renovascular hypertension with or without uraemia were analysed in 21 PTRA-treated and 16 operated patients. Most renal artery stenoses were atherosclerotic. Nineteen PTRAs were successful or partly successful and two failed; the patients were operated on without delay. All surgical reconstructions were successful. In the PTRA group six restenoses occurred after 4-24 months. Four were treated with re-PTRA and two were operated on. No recurrence occurred in the operated group. At the end of follow-up (median 48, range 9-84 months) primary patency in the PTRA group was 69 per cent and in the operated group 100 per cent. Secondary patency in the PTRA group was 100 per cent. With regard to hypertension, including primary and secondary results, 19 out of 21 (90 per cent) patients were improved in the PTRA group and 13 out of 16 (81 per cent) in the operated group. The diagnostic and preprocedure costs were the same in both groups, whereas the procedure and postprocedure costs were lower in the PTRA group. However, the follow-up costs were considerably higher because of recurrences and their treatment in the PTRA group. The total median cost of reconstructive surgery was 12 per cent higher than for PTRA, a non-significant difference.
对21例接受经皮腔内肾血管成形术（PTRA）治疗的患者和16例接受重建手术的肾血管性高血压患者（无论有无尿毒症）进行了研究，分析了与检查、治疗（PTRA或重建手术）及随访相关的临床结果和医疗费用。大多数肾动脉狭窄为动脉粥样硬化性。19例PTRA治疗成功或部分成功，2例失败；这些患者随即接受了手术。所有手术重建均成功。PTRA组有6例在4 - 24个月后出现再狭窄。4例接受了再次PTRA治疗，2例接受了手术。手术组未出现复发。随访结束时（中位时间48个月，范围9 - 84个月），PTRA组的一期通畅率为69%，手术组为100%。PTRA组的二期通畅率为100%。在高血压方面，包括主要和次要结果，PTRA组21例患者中有19例（90%）病情改善，手术组16例患者中有13例（81%）病情改善。两组的诊断和术前费用相同，而PTRA组的手术及术后费用较低。然而，由于PTRA组出现复发及其治疗，随访费用要高得多。重建手术的总中位费用比PTRA高12%，差异无统计学意义。
