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支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的影响

Effect of suprarenal fixation on renal function in endovascular abdominal aneurysm repair patients

摘要:

目的 评价支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的中、短期影响.方法 回顾性分析2005年3月至2009年12月290例接受腔内修复术的腹主动脉瘤患者的临床资料,根据移植物近端裸区是否超越肾动脉将患者分为肾上组和肾下组.肾上组173例,平均年龄(72±8)岁,男性占85.0%;肾下组117例,平均年龄(71±9)岁,男性占90.6%.记录两组患者术前,术后1周及术后1、3、6、12个月血清肌酐和胱抑素C的检测结果,并依据胱抑素C和血清肌酐计算肾小球滤过率.统计分析两组间及各组不同时间点的肾功能差异.结果 所有患者腔内修复均采用Talent或Zenith支架移植物,其中肾上组有67例使用Talent支架,106例使用Zenith支架;肾下组则分别有25例和92例,两组差异有统计学意义(P<0.05).两组患者其他术前及术中资料差异无统计学意义.肾上组和肾下组术后1周的血清肌酐为(98±11)μmol/L和(95±13)μmol/L,12个月时为(91±15)μmol/L和(90±12)μmol/L;1周时胱抑素C为(1.01±0.15)mg/L和(0.99±0.10)mg/L,12个月时为(1.03±0.20)mg/L和(1.02±0.21)mg/L,较术前升高,而肾小球滤过率降低(P<0.05).术后6个月,仅表现胱抑素C升高,肾上组(0.93±0.17)mg/L,肾下组(0.92±0.31)mg/L,依据胱抑素C计算的肾小球滤过率降低(P<0.05).术后各阶段两组间患者肾功能无差异.结论 与肾动脉开口远端放置支架修复腹主动脉瘤的方式相比,支架移植物裸区覆盖肾动脉开口不会更明显地损害患者肾功能.

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abstracts:

Objective To assess the the mid-term renal function of abdominal aortic aneurysm (AAA) patients following supra-renal endovascular repair. Methods From March 2005 to December 2009, 290 AAA patients were included and grouped depending upon whether they had received infra-renal (IR) or supra-renal (SR) EVAR. SR was performed in 173 patients, with a mean age of (72 ±8) years and 85.0% for male. IR was performed in 117 patients, with a mean age of (71 ±9) years and 90. 6% for male. Preoperative and 1 week, 1-, 3-, 6-, 12-month postoperative serum creatinine (Cr) and cystatin C (Cys-C) were detected. Estimated glomerular filtration rate (eGFR) were calculated by Cystatin-based formula and Cr-based Cockcroft formula. T test were used to determine statistical difference between or within groups. Results All Patients received Talent or Zenith endograft. The ratio of device-used were 67/106 in SR group and 25/92 in IR group ( P < 0. 05 ). The other characteristics and operative files in two groups were well matched. Preoperative Cr and Cys-C were ( 82 ± 8) μmol/L and (0. 89 ± 0. 11 ) mg/L for SR group, (81 ± 11 ) μmol/L and (0. 87 ± 0. 15) mg/L for IR group, no differents between groups.Compared to preoperative renal markers within each group, Cr, Cys-C and eGFR worsening were found at 1 week and 12 months postoperative(P <0. 05). At 1 week postoperative, Cr in SR group and IR group were (98 ±11) μmol/L and (95 ± 13) μ mol/L, Cys-C were (1.01 ±0. 10) mg/L or (0.99 ±0. 10) mg/L At 12 months postoperative, Cr in SR group and IR group were (91 ± 15) μmol/L or (90 ± 12) μmol/L,Cys-C were ( 1.03 ± 0. 20) or ( 1. 02 ± 0. 21 ) mg/L. Also, Cys-C [ SR: (0. 93 ± 0. 17 ) mg/L, IR: (0. 92 ±0. 31 )mg/L] and eGFR by Cys-C worsening were found at 6 months postoperative. There was no difference between groups in patients Cr, Cys-C and eGFR at each follow-up time interval. Conclusion The use of SR fixation was not significantly associated with mid-term postoperative renal injury.

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