Lankford N S, Donohue J P, Grim C E, Weinberger M H
J Urol. 1979 Oct;122(4):439-41. doi: 10.1016/s0022-5347(17)56454-x.
We have used a comprehensive protocol to identify secondary forms of hypertension and operated upon 77 patients with functionally significant renovascular disease. The population included 52 patients with atherosclerotic renal arterial lesions (31 unilateral and 21 bilateral) and 25 patients with fibrodysplasia (19 unilateral and 6 bilateral). In the entire population there was a 90% cured-improved rate, a 5% failure rate and a 5% postoperative mortality. The cure rate was highest in the unilateral fibrodysplasia group and lowest in those with bilateral atherosclerotic disease. The choice of initial operative approach was based on an attempt to preserve renal mass; in 11 patients vascular reconstruction was attempted and these required secondary nephrectomy because of early or late failure. All 11 patients had a good result after nephrectomy. Our observations indicate that a vigorous operative approach to renovascular hypertension is beneficial once accurate demonstration of a functionally significant lesion is made.
我们采用了一种综合方案来识别高血压的继发性形式，并对77例具有功能意义的肾血管疾病患者进行了手术。该人群包括52例动脉粥样硬化性肾动脉病变患者（31例单侧和21例双侧）和25例纤维发育不良患者（19例单侧和6例双侧）。在整个人群中，治愈率提高率为90%，失败率为5%，术后死亡率为5%。治愈率在单侧纤维发育不良组中最高，在双侧动脉粥样硬化疾病患者中最低。初始手术方法的选择基于保留肾实质的尝试；11例患者尝试了血管重建，由于早期或晚期失败，这些患者需要二次肾切除术。所有11例患者肾切除术后效果良好。我们的观察结果表明，一旦准确证实存在功能意义的病变，积极的手术方法治疗肾血管性高血压是有益的。
