经导管选择性动脉栓塞术治疗肾巨大血管平滑肌脂肪瘤的临床应用价值

目的：探讨经导管选择性动脉栓塞术治疗肾巨大血管平滑肌脂肪瘤（AML）的临床应用价值。 方法：回顾性分析我院2014年10月至2018年6月采用经导管选择性动脉栓塞术治疗6例肾巨大AML患者的资料，分析介入栓塞手术的成功率，比较栓塞前后瘤体大小，总结栓塞材料使用及术后并发症情况。 结果：6例患者共9个病灶，介入栓塞治疗7个病灶，另2个病灶较小予以随访观察。介入栓塞成功率100%。3例患者为肿瘤破裂大出血行急诊介入栓塞治疗。平均随访21.7个月（2~45个月），患者栓塞后瘤体最大径缩小（5.57±2.88）cm [（14.14±4.85）cm vs.（19.71±7.25）cm]，差异有统计学意义（t=4.54，P<0.05）。瘤体最大径缩小，患者疼痛症状逐渐缓解，出血情况消失。1例患者因病灶巨大并有生育要求行患肾全切除术。 结论：经导管选择性动脉栓塞术治疗肾巨大AML疗效确切，对于血供丰富的病灶或伴有较大动脉瘤、动静脉畸形时，组织胶碘化油混合物联合弹簧圈栓塞可能取得更持久的疗效。

Clinical efficacy of transcatheter selective arterial embolization in the treatment of renal giant angiomyolipoma

Objective:To evaluate the clinical efficacy of transcatheter selective arterial embolization in the treatment of renal giant angiomyolipoma. Methods:Between October 2014 and June 2018, six patients with renal giant angiomyolipoma were treated by transcatheter selective arterial embolization. Clinical data were retrospectively analyzed with respect to the success rate, embolism materials and postoperative complications. Results:Nine lesions in 6 patients were included, and 7 lesions were performed by selective arterial embolization, and conservative treatment performed in other 2 small lesions. Embolization was technically successful in all patients. Emergency arterial embolization was performed in 3 patients with spontaneous rupture of giant angiomyolipoma. The mean follow-up period was 21.7 months (ranging of 2 to 45 months) . After arterial embolization, the tumor maximum diameter was shrunk by (5.57±2.88) cm [ (14.14±4.85) cm vs (19.71±7.25) cm] with statistical significance (t=4.54, P<0.05) . The clinical symptoms of renal angiomyolipoma were markedly improved without hemorrhage. One patient underwent nephrectomy because of the large lesion and the requirement of childbirth. Conclusions:Transcatheter selective arterial embolization is an effective and safe treatment of renal giant angiomyolipoma. For lesions with abundant blood supply or with large aneurysm or arteriovenous malformations, the combination of histoacryl, lipiodol and coil may achieve better effect.