Mestres C A, Campistol J M, Ninot S, Botey A, Abad C, Guerola M, Cases A, Revert L, Mulet J
Department of Cardiovascular Surgery, Hospital Clínico y Provincial, University of Barcelona, Spain.
Br J Surg. 1988 Jun;75(6):578-80. doi: 10.1002/bjs.1800750626.
Between 1974 and 1986, 17 patients (16 men and 1 woman) with renal insufficiency (serum creatinine greater than 1.5 mg/dl, mean 3.75 mg/dl), with a mean age of 51.3 years, underwent surgical renal revascularization. Two of them were on maintenance haemodialysis. All were severely hypertensive in spite of antihypertensive drugs. Atherosclerosis was the cause of renal stenosis in 14 cases and fibromuscular dysplasia in 3. Operative procedures included splenorenal shunt (5), autotransplantation (3), aortorenal bypass (3), hepatorenal bypass (1), bilateral renal endarterectomy (1), renal ostial closure (1) and nephrectomy (3). Mean serum creatinine showed a decrease from 3.76 to 1.65 mg/dl (P less than 0.005). Mean arterial pressure dropped from 161 mmHg to 103 mmHg (P less than 0.001). Systolic and diastolic pressures also showed significant decreases. Two patients died. Four patients required a second operation and the renal function and blood pressure then improved. Renovascular disease must be ruled out in patients with renal insufficiency associated with hypertension, including those patients on haemodialysis. We conclude that renal revascularization surgery is a reliable and efficient form of treatment in selected cases of renal failure of renovascular origin.
1974年至1986年间，17例肾功能不全患者（16例男性，1例女性）接受了肾脏血管重建手术，这些患者血清肌酐大于1.5mg/dl（平均为3.75mg/dl），平均年龄51.3岁。其中2例患者正在接受维持性血液透析。尽管使用了抗高血压药物，所有患者均患有严重高血压。14例患者肾动脉狭窄的病因是动脉粥样硬化，3例为纤维肌性发育异常。手术方式包括脾肾分流术（5例）、自体肾移植术（3例）、主动脉-肾动脉搭桥术（3例）、肝-肾动脉搭桥术（1例）、双侧肾动脉内膜切除术（1例）、肾动脉开口闭合术（1例）和肾切除术（3例）。平均血清肌酐从3.76mg/dl降至1.65mg/dl（P<***0.005）。平均动脉压从161mmHg降至103mmHg（P<***0.001）。收缩压和舒张压也显著下降。2例患者死亡。4例患者需要再次手术，术后肾功能和血压得到改善。对于伴有高血压的肾功能不全患者，包括接受血液透析的患者，必须排除肾血管疾病。我们得出结论，对于某些肾血管性肾衰竭病例，肾脏血管重建手术是一种可靠且有效的治疗方式。
