肾动静脉瘘的选择性血管造影与栓塞治疗(附20例报告)

目的 提高肾动静脉瘘介入诊断和治疗水平。方法 20例患者均有反复间歇性全程肉眼血尿，曾行超声、KUB、IVU、CT、泌尿系内镜检查，未能明确病因。行选择性肾动脉造影或(和)超选择性肾段动脉造影确诊为肾动静脉多瘘，采用明胶海绵加鱼肝油酸钠／无水乙醇、聚乙烯醇(PVA)微粒、TH胶、钢圈等对病变血管选择性栓塞。对肾动脉造影的征象和选择性栓塞治疗资料进行分析。结果 20例按影像特点分3类：(1)肾内畸形血管团及动静脉分流现象，共11例；(2)肾动静脉大分支之间高流量的分流而无畸形血管团，共4例；(3)肾动脉主干造影末显示畸形血管团和显著分流，超选择肾段动脉造影或应用气体造影剂则显示微小分流病变，共5例。20例均采用超选择性栓塞供血动脉治疗，栓塞当天肉眼血尿即消失，24～72h后镜下血尿阴转。术后72h内术侧腰部均出现酸痛，尚有发热、腹胀、恶心等症状。结论 选择性肾动脉造影和栓塞术是肾动静脉瘘主要的诊断和治疗方法。CO2造影有助于隐匿型肾动静脉瘘的诊断。

Selective angiography and therapeutic embolization of renal arteriovenous fistula (report of 20 cases)

Objective To investigate angiographic manifestations and interventional treatment of renal arteriovenous fistulas. Methods Renal arterial angiographies were performed in 20 patients from multiple hospitals.These patients suffered from repeatedly intermittent hematuria,but ultrasound,KUB,IVU,CT and endoscopy could not contribute to the diagnosis.The angiographic manifestations and treating procedure were analyzed. Results All the 20 cases were diagnosed as renal arteriovenous fistula by means of angiography.According to the image manifestations,these cases were classified into three types:(1)deformed branches and shunt in 11 cases;(2)high discharge shunt without deformed banches in 4;(3)concealed shunt showed by superselective segmental artery angiography but negative by renal artery angiography in 5.All fistulas of the 20 cases were successfully embolized with different materials including gelfoam,sodium morrhuate,ethanol,PVA,TH-glue,coils,etc. Conclusions Superselective renal angiography and embolization are the most important and effective tools for diagnosis and treatment of renal arteriovenous fistula.