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Title: 遠隔成績からみた腎血管性高血圧に対する血行再建術の検討
Other Titles: Surgical treatment of renovascular hypertension with special reference to the indications for reconstructive surgery
Authors: 川村, 寿一  KAKEN_name
東, 義人  KAKEN_name
岡田, 裕作  KAKEN_name
吉田, 修  KAKEN_name
石川, 嘉市郎  KAKEN_name
原, 晃  KAKEN_name
熊田, 馨  KAKEN_name
Author's alias: Kawamura, Juichi
Higashi, Yoshihito
Okada, Yusaku
Yoshida, Osamu
Ishikawa, Kaichiro
Hara, Akira
Kumata, Kaoru
Keywords: Adult
Age Factors
Follow-Up Studies
Hypertension, Renovascular/surgery
Middle Aged
Renal Artery/pathology/surgery
Retrospective Studies
Issue Date: Jan-1983
Publisher: 泌尿器科紀要刊行会
Journal title: 泌尿器科紀要
Volume: 29
Issue: 1
Start page: 1
End page: 8
Abstract: 過去14年間に経験した38例の腎血管性高血圧症例を,血行再建術を行なった1群,腎摘出術を行なった2群,いろいろの理由で手術不能であった3群に分け,術前の臨床像と治療成績を検討した.その結果,血行再建術の適応となる要件は,若年者で高血圧の期間が短いこと,高血圧がレニン依存性で,狭窄が昇圧に有意に働いていること,総腎機能が保持され,患側の腎機能が悪すぎないこと,手術時に再建可能な病変であること,全身性の動脈硬化症は好ましくないこと,Surgical riskがよいこと,内科的治療に反応しない高血圧であること,などであることが明らかとなった.カプトリールやPercutaneous transluminal angioplastyなど非手術療法の普及もめざましいが,一生薬を服用し腎機能も低下してゆくことを考えると,上記の適応をみたす症例は,まず血行再建術が考慮されるべきであろう
Based on the retrospective analysis of 38 cases of renovascular hypertension treated by surgical intervention, the following indications are proposed for arterial reconstructive surgery: younger age of patient, short duration of hypertension, renin-mediated hypertension and extent and functional significance of the obstructing arterial lesion, favorable level of renal function in the affected side, and renal function threatened by advanced progressive vascular disease, surgically correctable lesion, and focal, unilateral renal arterial atherosclerosis without generalized atherosclerosis, good surgical risk, and hypertension not responding to medical treatment. Although the clinical use of the angiotensin I converting enzyme inhibitor and induction of percutaneous transluminal angioplasty can provide a new approach to non-surgical treatment for renovascular hypertension, the long-term use of antihypertensive drugs induces gradual decrease in renal function. Surgical treatment is best reserved for the patient on whom the available data meet the above criteria for vascular surgery.
PubMed ID: 6375307
Appears in Collections:Vol.29 No.1

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