超选择性节段性肾动脉栓塞治疗肾血管平滑肌脂肪瘤破裂出血

目的探讨超选择性节段动脉栓塞治疗肾血管平滑肌脂肪瘤破裂出血的临床价值。方法2001年1月-2008年1月,对16例肾血管平滑肌脂肪瘤破裂出血患者(4例病理证实)采用3F微导管超选择性肾动脉插管行病变供血动脉栓塞,其中平阳霉素 碘油栓塞8例、无水乙醇-碘化油栓塞8例,2例合并动脉瘤患者加用微弹簧圈栓塞。结果16例患者进行了23次治疗,其中8例为急诊栓塞。术后16例肾功能均无变化,未发生严重并发症。随访4个月～5年,血肿完全吸收,肿瘤大小从术前平均596.5cm3缩小为68.4cm3。2例巨大肿瘤首次栓塞后3年再出血栓塞治疗后手术切除,其余病例未复发出血。结论超选择性动脉栓塞治疗肾血管平滑肌脂肪瘤破裂出血是一种安全有效的治疗方法。

Superselective segmental renal arterial embolization for angiomyolipoma with rupture

Objective To study the clinical value of superselective segmental arterial embolization (SSAE)for renal angiomyolipoma (RAML) with rupture bleeding. Methods From Jan. 2001 to Jan. 2008, 16 cases of RAML with rupture and bleeding underwent SSAE were analyzed retrospectively. Among them, the embolus contained a mixture of absolute alcohol and lipidol in 8 cases, and an emulsion of pingyangmycin and lipidol in 8 cases. Two cases with complication of aneurysms were embolized by microcoil. Results Twent three SSAEs were performed in 16 cases, including 8 cases of emergency. After the procedure, renal function was normal and no complications occurred. During follow-up from 4 months to 60 months, hematomas were completely absorbed. Two massive tumors occurred with secondary hematomas due to rupture 3 years after the first embolization, and cared by partial nephrectomy after second SSAE. The average tumor sizes decreased from 596.5 cm3 to 48.4 cm3. Conclusion SSAE is a safe and effective method for RAML with rupture and bleeding.