Lobeck Inna N, Alhajjat Amir M, Dupree Phylicia, Racadio John M, Mitsnefes Mark M, Karns Rebekah, Tiao Greg M, Nathan Jaimie D
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Pediatr Surg. 2018 Sep;53(9):1825-1831. doi: 10.1016/j.jpedsurg.2017.12.008. Epub 2017 Dec 24.
Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.
We performed literature review and retrospective review (1993-2014) of children with renovascular hypertension at our institution. Response to treatment was defined by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents at most-recent follow-up.
We identified 39 patients with RVH. 54% (n=21) were male, with mean age of 6.93 ± 5.27 years. Most underwent endovascular treatment (n=17), with medication alone (n=12) and surgery (n=10) less commonly utilized. Endovascular treatment resulted in 18% cure, 65% improvement and 18% failure; surgery resulted in 30% cure, 50% improvement and 20% failure. Medication alone resulted in 0% cure, 75% improvement and 25% failure. 24% with endovascular treatment required secondary endovascular intervention; 18% required secondary surgery. 20% of patients who underwent initial surgery required reoperation for re-stenosis. Mean follow-up was 52.2 ± 58.4 months.
RVH treatment in children includes medications, surgical or endovascular approaches, with all resulting in combined 79% improvement in or cure rates. A multidisciplinary approach and individualized patient management are critical to optimize outcomes.
Retrospective comparative study LEVEL OF EVIDENCE: Level III.
儿童肾动脉闭塞性疾病的特征尚不明确；治疗方法包括药物治疗、血管内技术和手术。我们旨在描述肾血管性高血压（RVH）的病程、治疗方法及预后。
我们对本机构1993年至2014年期间患肾血管性高血压的儿童进行了文献回顾和回顾性研究。治疗反应根据儿童和青少年高血压国家高血压教育计划工作组在最近一次随访时的定义来确定。
我们确定了39例肾血管性高血压患者。54%（n = 21）为男性，平均年龄为6.93±5.27岁。大多数患者接受了血管内治疗（n = 17），单独使用药物治疗（n = 12）和手术治疗（n = 10）的情况较少见。血管内治疗的治愈率为18%，改善率为65%，失败率为免18%；手术治疗的治愈率为30%，改善率为50%，失败率为20%。单独使用药物治疗的治愈率为0%，改善率为75%，失败率为25%。接受血管内治疗的患者中有24%需要二次血管内干预；18%需要二次手术。初次接受手术的患者中有20%因再狭窄需要再次手术。平均随访时间为52.2±58.4个月。
儿童肾血管性高血压的治疗方法包括药物治疗、手术治疗或血管内治疗，所有这些治疗方法的综合改善率或治愈率为79%。多学科方法和个体化患者管理对于优化预后至关重要。
回顾性比较研究
三级
