介入化疗栓塞在治疗肾癌中应用的疗效评价

目的：评价肾癌术前进行肾动脉介入性化疗栓塞，对手术切除疗效的影响。方法：本组13例肾癌患者，先进行介和性化疗栓塞，48－72h后进行肾癌根治术。对手术疗效进行了回顾性研究。并设立11例仅行肾癌根治要的肾癌患者，作对照组进行对比。结果：本组13例肾癌患者，经过术前介入性治疗，12例成功地进行了肾癌根治术，1例由于周围组织广泛粘连未能手术切除。术后随访1年、3年及5年生存率分别为86％、63％及48％、63％及48％。结论：肾癌患者术前介和性治疗，有助于肾癌的切除，能够提高手术成功经，是治疗肾癌的重要辅助手段。     

经导管肾动脉栓塞的临床应用(附53例报告)

目的：对肾肿瘤及肾出血行肾动脉栓塞术的疗效及技术进行评价。方法：以明胶海绵、NT—CRE、线段、自体凝血块及无水乙醇用于栓塞肿瘤、先天性肾动静脉瘘和肾外伤出血，共53例。结果：41例术前辅助治疗的肾肿瘤在肾动脉栓塞后均成功进行了肾切除术，手术中平均输血405ml。4例晚期肾癌姑息性栓塞治疗者术后分别存活了3．5、13、17和25个月。1例先天性肾动静脉瘘和4例肾外伤出血在栓塞术后出血迅速停止，另1例先天性肾动静脉瘘出血，行超选择肾段动脉栓塞无效后又行肾切除术。结论：肾动脉栓塞术安全有效，可用于肾肿瘤的术前辅助治疗、晚期肾癌的姑息治疗及先天性肾动静脉瘘和肾外伤出血的治疗。     

超选择肾动脉化疗栓塞治疗老年性晚期肾癌

目的 探讨超选择肾动脉化疗栓塞治疗老年性晚期肾癌的疗效及意义。方法 对我科采用超选择肾动脉化疗栓塞治疗的37例老年（年龄70～77岁，平均74岁）晚期肾癌患者的临床资料及随访情况进行回顾性分析。结果 栓塞治疗后，所有患者症状与体征不同程度减轻甚至消失，如血尿消失，食欲、体重增加。术后1a．2a和3a生存率分别为59％、54％和22％。结论 超选择肾动脉化疗栓塞是老年性晚期肾癌首选的姑息疗法，碘油药物乳剂和明胶海绵颗粒是肾癌较佳的栓塞材料。     

肾癌伴腔静脉癌栓的介入治疗

目的 探讨肾癌尤其是伴有腔静脉癌栓的肾癌患者经肾动脉栓塞及经下腔静脉溶栓化疗的意义。方法 16例肾癌患者全部行肾动脉造影,16例中4例为术前栓塞,12例为治疗性栓塞,其中5例伴下腔静脉癌栓的患者除肾动脉栓塞外同时行腔静脉内溶栓化疗。结果 下腔静脉造影清晰显示腔静脉内癌栓形成,7例单纯肾动脉姑息性化疗栓塞患者术后主要症状均得以改善,生存1年以上者占71.4％。5例患者行经肾动脉化疗栓塞术及经下腔静脉溶栓化疗。术后1月复查症状无复发。5例中生存6个月以内者2例(40.0％),7～13个月者3例(60.0％)。结论下腔静脉造影对肾癌腔静脉内癌栓患者诊断敏感,肾动脉化疗栓塞并腔静脉溶栓化疗是此类患者重要的姑息治疗手段。其长期临床效果有待进一步观察。     

肾癌伴腔静脉癌栓的介入治疗

目的探讨肾癌尤其是伴有腔静脉癌栓的肾癌患经肾动脉栓塞及经下腔静脉溶栓化疗的意义。方法16例肾癌患全部行肾动脉造影,16例中4例为术前栓塞,12例为治疗性栓塞,其中5例伴下腔静脉癌栓的患除肾动脉栓塞外同时行腔静脉内溶栓化疗。结果下腔静脉造影清晰显示腔静脉内癌栓形成,7例单纯肾动脉姑息性化疗栓塞患术后主要症状均得以改善,生存1年以上占71．4％。5例患行经肾动脉化疗栓塞术及经下腔静脉溶栓化疗。术后1月复查症状无复发。5例中生存6个月以内2例(40．0％),7～13个月3例(60．0％)。结论下腔静脉造影对肾癌腔静脉内癌栓患诊断敏感,肾动脉化疗栓塞并腔静脉溶栓化疗是此类患重要的姑息治疗手段。其长期临床效果有待进一步观察。     

57例肾癌术前肾动脉栓塞和治疗性栓塞的疗效评价

目的对５７例肾癌术前肾动脉栓塞和治疗性栓塞技术与疗效进行评价。方法术前栓塞组３３例，对其手术过程和病理切片进行了回顾性研究。治疗性栓塞组２４例，对介入治疗前后症状和肿瘤大小变化做了统计学分析。两组患者均进行了随访，并设立对照组对生存率进行比较。结果病理研究显示肾动脉栓塞百分比与肿瘤坏死之间存在显著相关性，治疗性栓塞使患者症状明显缓解，瘤体缩小。随访术前栓塞组１、３和５年生存率分别为７２．７７％、６２７８％和４８３０％。治疗性栓塞组１、３年生存率分别为４１１８％和２６４８％。结论肾动脉栓塞有助于晚期肾癌的手术切除。术前栓塞可改善Ⅲ期患者的生存期，不能手术者可提高生存质量     

肾动脉栓塞加免疫疗法治疗晚期肾癌16例

肾动脉栓塞术治疗晚期肾癌,尤其是作为手术前的辅助治疗被广泛应用于临床。自1993年3月～2002年2月,我院对16例晚期肾癌患者采取肾动脉栓塞术,术后应用α-干扰素,白细胞介素-2治疗,效果满意,报道如下。     

无水乙醇术前肾动脉栓塞治疗肾癌的临床疗效分析

目的 评价肾癌术前肾动脉无水乙醇栓塞治疗的疗效.方法 32例肾癌患者,行患侧肾动脉无水乙醇逐级栓塞,明胶海绵栓塞肾动脉主干,2～5 d后行肾癌根治术,记录肿瘤切除率,术中失血量和手术时间.结果 32例栓塞后造影证实肾动脉完全栓塞,手术肿瘤切除率100%,术中见肿瘤缩小,肾表面静脉萎陷,肾周围水肿明显,出血少,手术时间短.结论 肾动脉栓塞可以减少手术出血,缩短手术时间,是肾癌的一种安全有效的治疗手段.     

选择性肾动脉栓塞术的应用价值

目的：评价肾动脉栓塞术在肾癌、肾血管平滑肌脂肪瘤和肾创伤出血病人中的应用价值。方法：对30例进行选择性肾动脉栓塞，其中16例肾癌中12例为术前栓塞，应用明肢海绵颗粒行肾动脉主干栓塞，4例为姑息性栓塞治疗，采用丝裂霉素C微球行末梢动脉栓塞并化疗；8例症状性肾血管平滑肌脂肪瘤，采用真丝线段行肾亚段动脉栓塞；6例肾创伤出血，采用自身血块、明胶海绵或弹簧钢圈行肾段动脉栓塞。结果：(1)肾癌术前栓塞者，肿瘤易剥离，手术野清晰，出血少。(2)肾癌姑息治疗者和症状性肾血管平滑肌脂肪瘤者。肿瘤体积明显缩小，症状显著改善。(3)肾创伤性出血者。止血迅速，不仅免于手术，而且能保留肾脏，不影响肾功能。结论：选择性肾动脉栓塞术简便、安全、有效。在肾肿瘤、止血治疗方面具有广阔的应用前景。     

晚期肾癌的栓塞治疗

目的：探讨晚期肾癌的栓塞方法及疗效。材料与方法：15例晚期肾癌患者，男性6例，女性9例，年龄34—78岁；8例为细胞学证实，7例为临床诊断；临床表现为血尿、腹部包块、持续性腹痛。13例瘤体〉8cm，2例瘤体〉10cm。分别行腹主动脉及双肾动脉造影，明确供血动脉后，对供血动脉行选择性插管，用明胶海绵及弹簧钢圈对患侧肾动脉及肾外供血动脉行完全性的栓塞治疗。结果：15例患者顺利完成了肾动脉栓塞治疗，其中4例腰动脉或髂动脉参与供血者对供血动脉行完全性栓塞，栓塞成功率专100％。术后患者临床症状明显改善，未出现不良反应及并发症。12例术后15天及3个月复查瘤体有明显缩小。结论：对无法手术的晚期肾癌用明胶海绵及弹簧钢圈行肾动脉及侧支供血动脉的单纯栓塞是安全、有效的。     

Percutaneous transluminal embolization for improved prognosis of renal cell carcinoma—Dependence on tumor stages

The effect of percutaneous transluminal embolization (PTE) on the prognosis of renal cell carcinoma, depending on tumor stage, was retrospectively investigate on 303 patients. The life-table method was used for statistical comparison of survival rates of preoperatively or palliatively embolized patients with those of patiens who merely underwent nephrectomy or were symptomatically treated. Preoperative PTE in tumor stages T₂ and T₃ resulted in extended survival rates, which were statistically significant in T₂ cases. Prognosis was also improved in patients who underwent palliative embolization as compared with those patients who were inoperable and received only symptomatic treatment. Prognosis following palliative PTE and delayed nephrectomy was not worse than that following preoperative PTE and immediate nephrectomy.     

超选择性肾动脉栓塞术治疗肾癌性血尿的效果观察

目的：评价超选择性肾动脉栓塞术治疗肾癌性血尿的临床效果。 方法：回顾性分析2015年1月至2018年1月内蒙古科技大学包头医学院第一附属医院介入治疗科收治的肾癌性血尿患者39例,男22例,女17例。患者经辅助检查均诊断为肾癌性血尿,均接受超选择性肾动脉栓塞术。术后第2、7、14、21天留取患者血液及尿液样本,行血常规及尿常规化验。 结果：39例患者均采用超液态碘油+明胶海绵微粒+明胶海绵颗粒栓塞,均一次栓塞成功,成功率达100%。其中,21例患者术后12 h肉眼血尿消失,18例术后24 h肉眼血尿消失。术后第2、7、14、21天,血红细胞数（RBC）、血红蛋白（Hb）、血细胞比容（HCT）水平均高于术前,尿RBC低于术前,差异均有统计学意义（P<0.01）。39例患者行栓塞术后均出现不同程度的栓塞综合征,临床表现为恶心、呕吐、发热及腰背胀痛等症状,经对症治疗2~5 d后消失。38例术后随访3~12个月,无一例发生异位栓塞、急性肾功能衰竭、肾坏死、肾脓肿等并发症。 结论：超选择性肾动脉栓塞术治疗肾癌可以起到终止血尿的作用,且有微创、安全可靠、并发症少等优点。     

Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma

Partial nephrectomy can be associated with vascular complications. Computed tomography (CT) with CT angiography is ideal for noninvasive imaging of this process. The treatment of choice is selective embolization. Successful transcatheter embolization of right renal subsegmental artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx was performed in a 66-year-old woman with macrohematuria 12 days after partial nephrectomy for renal cell carcinoma.     

Infarction of renal tumors using isobutyl-2 cyanoacrylate and lipiodol

Percutaneous transcatheter embolization of the renal artery in clear cell carcinoma was performed in nine patients. The occlusive material used was a suspension of 1 ml of isobutyl-2-cyanoacrylate in 3 ml of Lipiodol. Six patients were operated on 2-5 days after the embolization, and in three patients the procedure was palliative. In one of the latter, follow-up arteriography 4 months later showed that the artery was still occluded. There were no complications attributed to the glue or to oil emboli in this series.     

Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization

AIM: To present the imaging findings of five patients with renal artery pseudoaneurysm (RAP) after partial nephrectomy. METHODS: Five patients (four men and one woman) with RAP as a complication of partial nephrectomy were studied. The diagnosis of RAP was established using contrast-enhanced computed tomography (CT) in three patients and renal angiography in two patients. In two cases, the diagnosis was evident on ultrasound with colour Doppler. RESULTS: The indication for partial nephrectomy (open approach in four patients and laparoscopic in one patient) was a space-occupying lesion, which proved to be a renal cell carcinoma. All patients presented with macroscopic haematuria, 1-21 days (mean 12.2 days) after surgery. In three of patients the definitive diagnostic imaging method was contrast-enhanced CT. The arterial phase of CT showed a well-circumscribed dense collection of contrast material located within the renal parenchyma. In two other patients the initial and conclusive diagnostic imaging method was renal angiography. All patients underwent selective renal angiography with therapeutic coil embolization. The procedure failed in one patient, which necessitated nephrectomy. CONCLUSIONS: Pseudoaneurysm of the renal artery should be considered in patients presenting with macrohaematuria after nephron-sparing surgery. The diagnosis can be established using contrast-enhanced CT, ultrasound with colour Doppler, or angiography. Renal angiography with selective embolization is a safe and efficacious technique for managing the condition.     

超选择性肾动脉栓塞治疗创伤性肾出血

目的 探讨超选择性肾动脉栓塞治疗创伤性肾出血的应用价值。方法 20例创伤性肾出血患者在数字减影血管造影下，采用明胶海绵或(和)钢丝圈进行肾动脉栓塞。14例患者损伤在肾动脉一级分支以下，作超选择性肾动脉栓塞；6例患者肾动脉分支主干损伤或无法进行超选择性肾动脉栓塞者，作肾动脉主干或一级分支主干栓塞。结果 所有患者术后3～5d肉眼血尿消失。平均随访29个月，无肾出血复发，血尿素氮、肌酐及血压正常。术后复查：超选择性肾动脉栓塞治疗组，患肾未栓塞部分肾功能恢复，肾外形基本正常；非超选择性肾动脉栓塞治疗组，2例患肾无功能，4例患肾部分肾功能恢复。肾外形明显缩小。结论超选择性肾动脉栓塞术创伤小、疗效好、并发症少，能最大限度保护病肾功能，是治疗Ⅰ型、Ⅱ型闭合性肾损伤出血的安全有效方法。     

肾移植术后血管并发症的介入治疗

目的 探讨肾移植术后血管并发症介入治疗的价值。资料与方法 14例肾移植患者中，11例移植肾动脉狭窄，行球囊扩张或支架置入术；2例假性动脉瘤，行导管栓塞术；1例移植肾动脉血栓形成，行导管动脉溶栓术。结果 11例移植肾动脉狭窄患者均成功完成球囊扩张术，其中3例行支架置入术，术后患者血压均恢复正常，随3－35个月，未见狭窄；2例假性动脉瘤患者行栓塞术后，1例血流恢复正常，1例行移植肾摘除；1例移植肾动脉溶栓者，由于并发出血行移植肾摘除。结论 介入治疗是肾移植术后血管并发症有效的治疗方法。     

Is there still a place for angiography in the management of renal mass lesions?

In recent years, the development of noninvasive imaging modalities for exploration of the kidney has markedly reduced the use of angiography in the evaluation of renal masses. Presently, it is not required in routine practice to evaluate renal masses. Ultrasound is the most efficient procedure in detecting renal tumor. It is acknowledged that arteriography has a limited diagnostic and staging value compared with CT and MRI for the assessment of renal cell carcinomas (RCC). Most urologists recommend partial nephrectomy or tumor enucleation in an effort to preserve as much as possible functioning renal tissue. In such cases a preoperative map of the renal vasculature is not needed. Information on the main renal artery(ies) and segmental renal arteries can be provided with spiral CT or dynamic MR angiography. Arteriography remains useful in exceptional situations. Interventional arteriography is becoming an important part. It is indicated by means of selective embolization for the treatment of potentially bleeding tumor (i. e. angiomyolipoma) or in emergency in cases of acute hemorrhage. Less frequently, it may be proposed as a palliative procedure for inoperable patients with huge renal tumor. Two other indications of interventional arteriography are acknowledged. Some urologists request preoperative embolization of the tumor-harboring kidney to decrease/avoid extensive blood loss during surgery and/or to facilitate surgery with huge renal tumors when the renal vessels are difficult to reach. The complications of nephron-sparing surgery (partial nephrectomy or tumor enucleation) related to bleeding or arteriovenous fistulas may be cured by arterial embolization. Received: 18 May 1998; Revision received: 3 August 1998; Accepted: 6 August 1998