血管内栓塞治疗肾脏良性血管性病变

目的探讨选择性肾动脉栓塞治疗肾脏良性血管病变的临床价值。方法收集2008年3月至2011年7月肾脏良性血管病变患者27例,其中肾损伤12例(外伤8例,医源性损伤4例),肾血管畸形10例(动静脉畸形5例,动静脉瘘3例,动脉瘤2例),肾血管平滑肌脂肪瘤3例,多囊肾2例。27例中,血尿19例,腹部疼痛15例,腰部酸痛3例,低血压休克3例。术前均进行CT或MRI检查明确诊断。采用Seldinger技术穿刺行股动脉插管,先行肾动脉造影,了解病变性质、部位、范围、程度及血供情况,然后超选择插管至病变处,进行栓塞治疗。栓塞方法及栓塞剂的种类、剂量根据病变性质、造影表现及插管具体位置进行选择。术后随防1～36个月。结果 27例患者均由肾动脉参与病变供血。介入治疗后所有患者临床症状消失。随访中,除1例多囊肾患者栓塞后2个月又出现血尿外,其余患者均无相关临床症状复发,CT显示栓塞满意。结论血管内栓塞治疗肾良性血管性病变安全有效、创伤小、并发症少,并能最大程度地保护肾功能,是可靠的治疗方法。

Transcatheter endoluascular embolization for the treatment of benign renal vascular lesions

Objective To discuss the clinical value of superselective transcatheter arterial embolization in treating of benign renal vascular lesions.Methods A total of 27 patients with benign renal lesions,encountered during the period from March 2008 to July 2011 in the hospital,were collected.The lesions included renal trauma(n =8),iatrogenic damage(n = 4),renal vascular malformations such as arteriovenous malformation(n =5),arteriovenous fistulae(n = 3) and aneurysms(n = 2),renal angioliomyolipoma(n = 3) and polycystic kidney disease(n = 2).Clinical manifestations included hematuresis(n = 19),abdominal pain(n = 15),backache(n = 3) and hypotension shock(n = 3).The diagnosis was confirmed by preoperative CT scanning or MRI in all patients.Using Seldinger technique,the catheterization of the femoral artery was performed,which was followed by renal artery angiography to clarify the lesion′s nature,location,extent,degree of severity and blood supply,and then superselective catheterization to the lesion’s site was accomplished to complete the embolization procedure.The embolization technique,embolization agents and doses were decided according to the lesion′s location and angiographic findings.The patients were followed up for 1-36 months.Results The lesions were correctly diagnosed in all patients by selective angiography.The renal artery participated in the blood supplying of the lesions.After the interventional treatment,the clinical symptoms disappeared in all patients.During the follow-up period,no recurrence of primary disease-related symptoms was observed in all patients except for one patient with polycystic kidney disease who developed hematuria two months after the embolization treatment.Conclusion For the benign renal vascular lesions,superselective transcatheter embolization is an effective,safe,reliable and minimally-invasive treatment with fewer complications,besides,this technique can preserve the renal function to the greatest possible advantage.