非肿瘤性肾动静脉畸形或瘘节段性肾动脉栓塞治疗

目的　分析非肿瘤性肾动静脉畸形或瘘引起肾出血节段性肾动脉栓塞治疗的方法及疗效 ,探讨栓塞后肾脏再出血的原因及处理措施。方法　 4例肾出血患者 ,其中 2例先天性肾动静脉畸形 (AVM) ,2例肾穿刺后并发肾动静脉瘘 (AVF)。经股动脉插管行肾动脉及其分支造影 ,用明胶海绵、钢丝圈或无水酒精超选择性栓塞病变血管。结果　 4例畸形血管均闭塞 ,出血停止 ,全部病例在栓塞后无严重并发症发生 ;1例先天性AVM病人用钢丝圈及明胶海绵栓塞 8个月后再出血 ,经无水酒精再次栓塞后出血停止 ,随访 9个月无再出血。结论　肾动脉造影是诊断肾脏AVM和AVF的可靠方法 ;节段性肾动脉栓塞术是治疗肾脏AVM和AVF有效、安全的微创性手术 ;少数病例再发出血 ,可能与栓塞剂类型的选择和病变的特点有关 ,需应用永久性栓塞剂或多种栓塞剂联合治疗 ,甚至外科手术处理。

Segmental Renal Arterial Embolization for Non -neoplastic Renal Arteriovenous Malformations or Fistulas

Objective To evaluate the method and role of segmental renal arterial embolization(SRAE) in treating non-neoplastic renal arteriovenous malformations or fistulas with renal hemorrhage.To probe the reasons and management of renal re-hemorrhage after SRAE.Methods 2 patients with congenital renal arteriovenous malformations(AVM) and 2 cases with acquired renal arteriovenous fistulas(AVF) after renal puncture were treated with SRAE.Embolic materials consisted of steel coils,gelatin sponge and absolute alcohol.Results All 4 cases were performed successfully.The feeding arteries of the AVM or AVF were eliminated by super-selective embolization.No severe complications occurred after embolization.There was one case of recurrence 8 months after treatment,but bleeding was stopeed by SRAE again with absolute alcohol and has not recurred for 9 months following up.Conclusion Renal arteriography is a reliable method in the diagnosis of renal AVM or AVF.SRAE is a save,efficient and mini-invasive technique for treatment of renal AVM or AVF.The reasons for recurrence in some patients may be related to the kind of embolic materials used and the characteristics of disease.It is necessary for those patients to be treated further,even partial nephrectomy.