肾血管平滑肌脂肪瘤的DSA特征性表现及介入栓塞治疗

The Renal Angiomyolipoma: Characteristics of DSA Appearances and Embolotherapy

目的：研究肾血管平滑肌脂肪瘤（ＡＭＬ）的ＤＳＡ特征性表现及介入栓塞治疗问题。材料与方法：１５例症状性肾ＡＭＬ，男５例，女１０例，平均年龄４６岁。经Ｂ超和／或ＣＴ诊断正确１０例，误诊５例。全部病例接受ＤＳＡ检查，并用自制的中药白芨粉粒作血管栓塞剂，超选择性肾动脉栓塞治疗７例，另外８例接受手术治疗。结果：１５例均被ＤＳＡ诊断为肾ＡＭＬ。其特征性表现为：动脉期，肿瘤内中小动脉葡萄串状假性动脉瘤形成（１４例）；实质期，肿块内单个或多个界限清楚的充盈缺损区（１０例）；静脉期，肿块呈漩涡状葱皮样外观（８例）。６例分别经导管肾动脉内注入肾上腺素１０μｇ，进行药物性血管造影，见病变血管均不收缩，此表现同肾癌一样。７例接受栓塞治疗后，临床症状均于５～１０天内消失，其中５例随访１０个月～３年，未见复发。结论：ＤＳＡ诊断肾ＡＭＬ较具特异性，栓塞治疗简便、安全。

Objective: To study the characteristics of DSA appearances and the embolotherapy of the renal angiomyolipoma (AML). Materials and Methods: 15 cases of symptomatic AML, 5 male and 10 female, with average 46 years old, 10 were made accurate diagnosis with the examinations of B type ultrasonography (B US) and/or CT scanning, 5 were misdiagnosed. All patients were examinated with DSA, and 7 cases were treated with superselective renal arterial embolization using the self produced Bletilla Striata powder as a vascular embolus, 8 were treated with surgical operation.Results: 15 patients were accurately diagnosed as AML with DSA. The DSA characteristics appearances of the AMLs were the graped like pseudoaneurysms in the arterial phase (n=14), the defined filling defect areas in the nephrogram phase (n=10) and the oniony peel appearances in the venous phase (n=8). The angiography was performed in 6 patients by transcatheter intrarenal arterial injection of 10μg adrenaline, the lesion vessels did not contract. After embolotherapy in 7 patients, the original symptoms were relieved in 5～10 days, without recurrence in 5 patients who were followed up for 10 months to 3 years.Conclusion: The diagnosis with DSA was more specific and the embolotherapy was easy, safe and efficient for AML.