Jegaden O, Martin X, Canton F, Gelet A, Dubernard J M
Service d'Urologie, Hôpital Edouard-Herriot, Lyon.
J Mal Vasc. 1987;12(4):315-8.
Sixteen patients underwent surgical treatment for severe renovascular hypertension with rapidly progressive renal failure. These patients were assessed preoperatively with the measurement of serum creatinine and blood-urea levels (means 271 +/- 204 mumol/l and 15.6 +/- 10.3 mmol/l respectively), and renal clearances. 5 patients underwent aorto-renal bypass (bilateral in one case) and 11 patients were treated by autotransplantation of the kidney. Operative mortality was 6.2%. Early results were assessed at 1 and 6 months postoperatively. Renal function was normal in 8 patients, improved in 5 (p less than 0.05), unchanged in 1 and worse in 1 by aorto-renal bypass thrombosis. At long-term with a minimum follow-up of 12 months (mean 31 +/- 12 months), the initial improvement in renal function remained steady in 12 patients whilst 1 patient has gone on to hemodialysis. At middle and long-term, 81% of the patients were normotensive without medication or had improved blood pressure (p less than 0.001). These good results confirm the reversibility of renal ischemic lesions and support an aggressive attitude towards the use of revascularization in the surgical treatment of such patients with renovascular hypertension and renal failure.
16例严重肾血管性高血压伴快速进行性肾衰竭患者接受了手术治疗。术前对这些患者进行了血清肌酐和血尿素水平测定（均值分别为271±204μmol/L和15.6±10.3mmol/L）以及肾脏清除率评估。5例患者接受了主动脉-肾动脉搭桥术（1例为双侧），11例患者接受了自体肾移植治疗。手术死亡率为6.2%。术后1个月和6个月对早期结果进行了评估。8例患者肾功能正常，5例改善（p<0.05），1例无变化，1例因主动脉-肾动脉搭桥血栓形成而恶化。长期随访，最短随访12个月（平均31±12个月），12例患者肾功能的初始改善保持稳定，1例患者已开始血液透析。在中长期，81%的患者无需药物治疗血压正常或血压有所改善（p<0.001）。这些良好结果证实了肾缺血性病变的可逆性，并支持在对此类肾血管性高血压和肾衰竭患者进行手术治疗时积极采用血管重建术。
