选择性肾动脉栓塞治疗肾脏疾病的临床应用

目的：评价选择性肾动脉栓塞治疗在肾癌、症状性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：采用改良Seldinger技术经皮股动脉穿刺插管，对68例进行选择性肾动脉栓塞治疗，其中30例为肾癌术前辅助治疗，应用明胶海绵颗粒栓塞；8例为晚期肾癌姑息性治疗，采用丝裂霉素＋碘油的乳剂行末梢栓塞，然后用明胶海绵行肾动脉主干栓塞；6例症状性肾血管平滑肌脂肪瘤，采用真丝线段栓塞；24例肾创伤出血，采用自身血块、明胶海绵或弹簧钢圈栓塞。结果：肾癌术前栓塞者，术中肿瘤易剥离，手术野清晰，出血量少，手术时间缩短；晚期肾癌姑息治疗和症状性肾血管平滑肌脂肪瘤者，栓塞术后1~3周临床症状显著改善，3个月后肿瘤体积明显缩小，平均缩小65.6%；肾创伤性出血者，止血迅速，不影响肾功能。全部病例在栓塞治疗后无严重并发症发生。结论：选择性肾动脉栓塞术是治疗肾脏疾病的一种微创、安全、有效的方法，并发症少，可用于肾癌术前辅助治疗、晚期肾癌的姑息性治疗及肾血管平滑肌脂肪瘤和肾创伤出血的治疗，值得临床推广应用。

Clinical application of selective renal artery embolization in treating renal diseases

Objective: To evaluate the clinical value of selective renal artery embolization for renal carcinoma, symptomatic renal angiomyolipoma and traumatic renal hemorrhage. Methods: Selective renal artery embolization was performed in 68 patients via femoral artery with Seldinger technique, 30 cases were embolized with gelatin sponge chips before operation for renal carcinoma, and 8 cases were embolized with MMC and iodized oil, and gelatin sponge for palliative treatment of advanced renal carcinoma, 6 cases were embolized with thread segments for symptomatic renal angiomyolipoma, 24 cases were embolized with self blood coagulum, gelatin sponge and/or steel coils for traumatic renal hemorrhage. Results: In renal carcinoma, after renal artery embolization during operation, less bleeding, less operation time because of clear operation field. Clinical symptoms were improved obviously 1~3 weeks after treatment, and the tumor mass was decreased evidently with an average shrinkage of 65.6%, 3 months after embolization in symptomatic renal angiomyolipoma and advanced renal carcinoma for palliative treatment. The hemorrhage had been successfully controlled by means of renal artery embolization, and the renal function was maintained as much as possible. No severe complications occurred after embolization in all the patients. Conclusion: As a minimal invasive technique, selective renal artery embolization is a safe and effective method with less complication for treatment as an adjuvant pre-operative therapy for renal carcinoma or a palliative treatment for advanced carcinoma and an effective treatment for symptomatic renal angiomyolipoma and traumatic renal hemorrhage. Renal artery embolization should be widely applied for these renal diseases.