复杂性肾动脉瘤诊治

目的 探讨复杂性肾动脉瘤(RAA)的特点及诊治方法.方法 1999年3月至2008年9月收治复杂性RAA患者5例.女4例,男1例.平均年龄35(20～54)岁.腰痛伴血尿2例、腹痛伴休克i例、高血压1例、查体发现1例.RAA直径平均3.5(0.5～9.0)cm.单侧3例、双侧2例.5例均经数字减影血管造影确诊.保守治疗1例、肾动脉栓塞后肾切除1例、超选择性肾动脉栓塞1例、覆膜支架介入治疗1例、肾分支动脉结扎1例.结果 1例孤立肾多发动脉瘤破裂出血者保守治疗5 d死亡;1例肾上极1.5 cm动脉瘤,超选择性肾动脉栓塞后随访10个月未见复发;1例直径9.0 cm肾动脉瘤经肾动脉栓塞后行肾切除,随访12个月未见复发;1例肾内3.0 cm动脉瘤行覆膜支架介入治疗,随访12个月未见复发;1例右肾2.5 cm动脉瘤行右肾分支动脉结扎,10个月后发现左肾1.3 cm动脉瘤.随访24个月左肾RAA无变化,右肾RAA无复发.结论 直径＜2 cmRAA可密切观察,复杂性RAA治疗应根据患者一般状况、症状,动脉瘤大小、数目、部位、肾功能、有无并发症等选择手术或介入治疗.

Diagnose and management of complicated renal artery aneurysm

Objective To discuss the methods of diagnose and management of complicted renal artery aneurysm(RAA).Methods The clinical data of 5 patients who diagnosed for RAA were analyzed retrospectively.One was male and the other 4 cases were female with mean age of 35 years old.Diameter range of RAA was 0.5-9.0 cm(mean 3.5 cm).Three case were solitary RAA and 2 case was bilateral.Clinicsl manifestations included flank pain and hematuria in 2 cases,abdominal pain with hemorrhagic shock in 1 case and hypertension in 1 case.Color ultrasonic diagnosed parapelvic cyst with calcification,hydronephrosis and RAA.All 5 cases were confirmed by angiography of renal artery.Results A solitary reual with multiple RAA burst died 5 days after dignosed without surgical treatment.One giant RAA which diameter was 9.0 cm was undergone embolism of renal artery and then performed nephrectomy.The other 3 cases underwent super selective renal artery embolization,endovascular treatment with stent-graft and selective renal artery ligation.Renal-sparing cases were followed-up for 10,12 and 24 months without recurrence.Conclusions If RAA is no more than 2 cm in diameter,the watchful waiting is feasible.The operation or endovascular treatment should be taken according to patient situation,symptom,renal function,complication and condition of RAA such as size,number and location.