先天性肾动静脉畸形的栓塞治疗

目的评价经导管动脉栓塞治疗先天性肾动静脉畸形的价值。方法回顾性分析7例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用明胶海绵、无水乙醇、弹簧钢圈等对病变血管进行栓塞治疗。结果所有7例先天性肾动静脉畸形都成功栓塞,栓塞24h内7例肉眼血尿消失,术后1周内可有栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,但无严重并发症。随访36～98个月无血尿复发,肾功能正常。结论经导管肾动脉造影能明确诊断,动脉栓塞安全有效,对先天性肾动静脉畸形的治疗有重要意义。     

无水乙醇栓塞治疗先天性肾动静脉畸形

目的 探讨经微导管无水乙醇动脉栓塞治疗先天性肾动静脉畸形的疗效和安全性.方法 回顾性分析11例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用无水乙醇栓塞病变血管治疗.结果 11例患者共进行12次治疗,无水乙醇用量5～25 ml,11例肾动静脉畸形均成功栓塞,栓塞24～48 h内肉眼血尿消失.术后1周内出现栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,无其他严重并发症.随访4～96个月无血尿复发,肾功能正常.结论 经导管无水乙醇动脉栓寨安全有效、费用低廉,是先天性肾动静脉畸形治疗的有效方法.     

经皮肾镜取石术后肉眼血尿的超选择性动脉栓塞治疗

目的 探讨经皮肾镜取石术(PCNL)后无痛性肉眼血尿的原因及经导管超选择性插管肾动脉栓塞治疗(KAE)的方法和疗效.方法 共7例PCNL后持续性全程无痛性肉眼血尿患者,男5例,女2例,年龄38 ～ 64岁,平均52岁.PCNL后3～5天,左肾2例,右肾5例,7例患者均有持续性全程无痛性肉眼血尿,血压难以维持.治疗方法:采用Seldinger穿刺技术进行股动脉穿刺插管,做选择性患侧肾动脉造影,检出出血原因后超选择性插入供血动脉,用医用明胶海绵颗粒或弹簧钢丝圈栓塞靶血管,栓塞后立即造影复查.结果 7例患者均发现有肾动脉分支假性动脉瘤(RAP),其中2例合并动静脉瘘(AVF);7例患者经栓塞治疗后出血停止,血压恢复正常.栓塞前后肾功能无显著变化.结论 DSA检查是确诊PCNL后全程无痛性肉眼血尿原因的较好办法,PCNL后全程无痛性肉眼血尿的直接原因主要是肾动脉分支RAP和AVF,KAE是治疗PCNL后RAP及AVF的安全性高、疗效肯定的治疗方法.     

肾段及亚段疾病血管栓塞术的临床应用

目的：探讨经肾动脉手管超选择至肾段及肾亚段对肾肿瘤及肾动静脉畸形进行栓塞治疗的临床应用价值。方法：4例肾肿瘤患，经导管超选择至肾段及肾亚段，行化疗栓塞术。8例肾动静脉畸形均经DSA证实，经导管超选择性插管至肾段及肾亚段行栓塞治疗。栓塞材料为弹簧图、无水酒精、PVA或IBCA。结果：4例肾肿瘤患节段性栓塞均获得成功，治疗后肿瘤缩小，碘油沉积良好，CT复查肿瘤平均6个月无复发，相邻的肾段无梗死征象。8例肾动静脉畸形患超选择性栓塞均获得成功。1例术后6个月血尿复发，再次栓塞后血尿症状消失，其余未见复发。结论：肾段及肾亚段栓塞是治疗无手术适应证的肾脏肿瘤及肾动静脉畸形的有效方法，互能够最大限度的保护正常肾脏，并发症少。     

非获得性肾动静脉瘘的血管造影诊断和介入治疗

目的小结非获得性肾动静脉瘘的血管造影表现和介入治疗,提高对该病的认识.方法回顾性地分析了13例非获得性肾动静脉瘘的肾动脉造影表现和选择性血管栓塞治疗.结果肾动静脉瘘的动脉造影表现主要归纳为畸形血管、动静脉短路,多分支供血等,选择性供血分支的栓塞能有效地止血.结论选择性肾动脉造影和栓塞术是诊断和治疗肾动静脉瘘的最重要的方法.     

经导管肾动脉节段性栓塞治疗肾动静脉畸形

目的：探讨经导管肾动脉节段性栓塞治疗肾动静脉畸形的栓塞材料及其效果。方法：9例因肾动静脉畸形（先天性者8例，获得性者1例）引起大量血尿患者，施行经导管肾动脉节段性栓塞治疗10次，栓塞材料为无水乙醇、聚乙烯醇颗粒、异丁基-2-氰基丙烯酸酯和弹簧圈。9例患者术后随访观察10-56个月。结果：9例患者栓塞术后肾动脉造影显示畸形血管完全闭塞，3d内血尿消失。随访期间，9例患者中，只有1例单纯应用弹簧圈栓塞患者术后6个月血尿复发，血管造影证实为侧支血管形成导致畸形血管再通，改行无水乙醇及弹簧圈栓塞，术后18个月血尿未再复发。9例患者均无严重并发症发生。结论：经导管肾动脉节段性栓塞是治疗肾动静脉畸形的安全有效的方法，栓塞材料以无水乙醇和弹簧 圈联合栓塞为最佳。     

经导管肾段或亚段栓塞治疗肾动静脉畸形

探讨肾动静脉畸形的栓塞方法及栓塞剂选择。３例肾动静脉畸形均经ＤＳＡ主宰经导管超选择性肾段或亚段栓塞。检测剂为弹簧圈，无水酒精和ＩＢＣＡ。结果；３例肾动静脉畸形超靠拢性栓塞的均获成功。     

选择性肾动脉栓塞治疗肾造瘘术后出血

目的评价选择性肾动脉栓塞治疗肾造瘘术后出血的临床价值。方法对12例肾造瘘术后出血患者,使用选择性肾动脉栓塞术,栓塞材料为明胶海绵微粒、聚乙烯醇(PVA)微粒或弹簧圈。结果造影显示肾实质动静脉瘘2例;对比剂外溢4例;假性动脉瘤3例;假性动脉瘤合并动静脉瘘3例。栓塞治疗后异常血管征象消失,12例患者的血尿3～7d内消失,随访期间未出现严重并发症及再次血尿。结论选择性肾动脉栓塞是治疗肾造瘘术后出血的微创、安全、有效的方法。     

肾动,静脉瘘致持续性血尿的栓塞治疗

肾动、静脉瘘致持续性肉眼血尿是很少见的病例,笔者使用5F 导管超选肾动脉及其分支并用碘化油栓塞治疗由肾动、静脉瘘引起的持续性血尿患者2例。现报告如下。     

医源性肾损伤超选择性肾动脉栓塞的临床疗效及相关因素分析

目的 探讨影响超选择性肾动脉栓塞术治疗医源性肾损伤的临床疗效及预后的相关因素.方法 10例医源性肾损伤患者,均为男性,平均年龄47.4岁.术后发病时间最长60天,最短l天,平均3天.临床均表现为肉眼血尿,其中9例经皮肾镜取石术后,1例为肾病经皮穿刺活检术后.经CT检查见肾实质出现征象,行统一标准的肾脏数字血管造影,表现为对比剂外溢或动静脉瘘,明确出血血管后,行超选择性肾动脉栓塞.术前1天和术后5天分别检测肾功能,并行配对t检验.结果 10例患者均成功进行损伤靶血管的栓塞术,9例表现为对比剂外溢征象,1例表现为动静脉瘘;9例为下极动脉,1例为上极动脉.栓塞后即刻造影,责任动脉未见对比剂外溢或静脉早现.术后随访1～24个月,无再发肉眼血尿,栓塞术后肉眼血尿消失时间最长者7天,最短1天,平均2.2天.肾功能较术前显著改善(P=0.03),无严重并发症.结论 超选择肾动脉栓塞术治疗医源性肾损伤出血安全、有效.     

Arteriovenous malformations of the kidneys: ablation with alcohol

Ablation of renal arteriovenous malformations with absolute alcohol was performed in seven patients with massive hematuria. In three patients, total occlusion of the malformations was accomplished by ablation of two arterial branches. In the remaining four patients, the malformations were partially occluded by ablation of one or two arterial branches. In addition to ablation with alcohol, two of the four patients underwent subselective embolization with Gelfoam (absorbable gelatin sponge) under epinephrine pharmacoangiography, which resulted in the disappearance of the remaining malformations. None of the patients had serious complications from ablation with alcohol, although dyspnea and headache occurred in one patient with marked arteriovenous shunting. During long-term follow-ups, hematuria disappeared in six patients. In the remaining patient hematuria recurred but did not require treatment. These data suggest that alcohol ablation is useful and safe in the treatment of renal arteriovenous malformations.     

Amplatzer封堵器栓塞肺血管瘘道畸形

目的 评价Amplatzer封堵器作为新型栓塞材料在治疗肺血管瘘道畸形的临床价值。方法 肺血管瘘道畸形5例，包括肺动静脉瘘4例与肺动脉左房瘘1例，采用Amplatzer封堵器对供血动脉行经导管封堵治疗。结果 5例栓塞均获得技术成功，未见封堵器脱落移位，局部右向左分流消失，股动脉血氧饱和度由术前78.2％上升至术后94.5％。结论 Amplatzer封堵器用于肺血管瘘道畸形的经导管治疗安全可靠，近期疗效满意。     

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。     

肝癌介入术中动静脉瘘的评判与处理

目的 分析肝癌动静脉瘘(AVS)的DSA表现,寻找与其相适应的瘘口封堵方法,改善合并AVS 肝癌的治疗效果.方法 通过对637例患者中发现的183例AVS进行影像学分析,对轻度AVS患者在碘油栓塞后进行供血动脉栓塞,对中、重度患者先行瘘口处理,保证药物在肿瘤组织中的有效灌注与碘油在瘤组织中的良好沉积.结果 89例轻度AVS碘油栓塞后都能成功地进行肿瘤供血动脉的栓塞,94例中、重度患者中68.1%(64例)封堵后碘油得到良好或较好沉积,14.8%(13例)栓塞不完全,进行单纯化疗药物灌注,11.7%(11例)过度栓塞导致碘油沉积不满意,6.4%(6例)痿口过大或瘘口过于弥漫未能封堵.未发生严重并发症.结论 绝大多数肝癌伴AVS患者都能得到有效的瘘口封堵,改善了肝癌合并AVS的疗效,对瘘口的栓塞处理是安全、可靠的.     

How Do We Treat Arteriovenous Malformations (Tips and Tricks)?

Ethanol embolization is sufficient to eliminate or improve symptoms of arteriovenous malformations (AVMs) in a high percentage of patients, but with substantial risk of minor and major complications. Inadvertent embolization must be avoided by superselective catheterization or direct puncture of the nidus. According to the angiographic morphology of the nidus, AVMs of the trunk and extremities can be classified into four types: type I (arterio-venous fistulae), type II (arteriolo-venous fistulae), type IIIa (arteriolo-venulous fistulae without dilation of the fistula), and type IIIb (arteriolo-venulous fistulae with dilation of the fistula). The described angiographic classification provides considerable information concerning the characteristics of AVMs in the body and extremities, the optimal therapeutic approach, and the likely therapeutic outcome.     

Angiographic Findings and Embolotherapy in Renal Arterial Trauma

Purpose To evaluate the angiographic findings and embolotherapy in the management of traumatic renal arterial injury Methods This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutaneous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review.Results Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto–pedestrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriovenous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnormal vessels was performed using coils in 9 patients, microcoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no procedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post-embolization nephrectomy to prevent infection. Follow-up ranged from 1 month to 7 years (mean 31 months). No procedure-related or delayed onset of renal insufficiency occurred.Conclusion In hemodynamically stable and controlled patients selective and superselective embolization is a safe and effective method for the management of renal vascular injury     

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。