Moncure A C, Brewster D C, Darling R C, Atnip R G, Newton W D, Abbott W M
J Vasc Surg. 1986 Feb;3(2):196-203. doi: 10.1067/mva.1986.avs0030196.
During a 16-year period at the Massachusetts General Hospital 77 patients underwent 79 procedures (29 hepatorenal bypasses, 50 splenorenal arterial anastomoses) for treatment of renovascular hypertension, renal preservation, or both. The procedure was chosen primarily to avoid a diseased or scarred aorta in 41, to allow a staged approach to bilateral renal artery stenoses or multiple vascular lesions in 17, as a "lesser operation" for five poor-risk patients, for complex problems including trauma, mycotic aneurysm, aortic dissection, thoracoabdominal aneurysm, and renal artery aneurysm in five, and as the procedure of choice in 11 patients. The perioperative mortality rate was 6% for the 77 patients studied. No hepatic dysfunction was seen. Deterioration of renal function occurred on three occasions but only in patients with bilateral simultaneous repair. Cure or improvement of hypertension was achieved in 52 of 63 patients and renal function preserved or improved in 67 of 77 patients. Long-term functional results remain good during follow-up periods up to 14 years. Our experience indicates that use of the hepatic or splenic artery may provide a safe and largely successful alternative for renal revascularization in selected circumstances.
在马萨诸塞州总医院的16年期间，77例患者接受了79次手术（29次肝肾旁路手术，50次脾肾动脉吻合术），用于治疗肾血管性高血压、保留肾脏或两者兼顾。选择该手术主要是为了避免41例患者的主动脉病变或瘢痕形成，使17例双侧肾动脉狭窄或多处血管病变患者能够分阶段进行治疗，作为5例高危患者的“较小手术”，用于处理包括创伤、霉菌性动脉瘤、主动脉夹层、胸腹主动脉瘤和肾动脉动脉瘤在内的复杂问题5例，以及作为11例患者的首选手术。在研究的77例患者中，围手术期死亡率为6%。未观察到肝功能障碍。肾功能恶化发生过3次，但仅发生在双侧同时修复的患者中。63例患者中有52例高血压得到治愈或改善，77例患者中有67例肾功能得到保留或改善。在长达14年的随访期内，长期功能结果仍然良好。我们的经验表明，在特定情况下，使用肝动脉或脾动脉可能为肾血管重建提供一种安全且基本成功的替代方法。
