复杂性肾动脉瘤诊治

Diagnose and management of complicated renal artery aneurysm

目的探讨复杂性肾动脉瘤（RAA）的特点及诊治方法。方法1999年3月至2008年9月收治复杂性RAA患者5例。女4例，男1例。平均年龄35（20－54）岁。腰痛伴血尿2例、腹痛伴休克1例、高血压1例、查体发现l例。RAA直径平均3．5（0．5～9．0）cm。单侧3例、双侧2例。5例均经数字减影血管造影确诊。保守治疗1例、肾动脉栓塞后肾切除1例、超选择性肾动脉栓塞1例、覆膜支架介入治疗1例、肾分支动脉结扎1例。结果1例孤立肾多发动脉瘤破裂出血者保守治疗5d死亡；1例肾上极1．5cm动脉瘤，超选择性肾动脉栓塞后随访10个月未见复发；1例直径9．0cm肾动脉瘤经肾动脉栓塞后行肾切除，随访12个月未见复发；1例肾内3．0cm动脉瘤行覆膜支架介入治疗，随访12个月未见复发；1例右肾2．5cm动脉瘤行右肾分支动脉结扎，10个月后发现左肾1．3cm动脉瘤，随访24个月左肾RAA无变化，右肾RAA无复发。结论直径〈2cmRAA可密切观察，复杂性RAA治疗应根据患者一般状况、症状，动脉瘤大小、数目、部位、肾功能、有无并发症等选择手术或介入治疗。

Objective To discuss the methods of diagnose and management ot comphcted renal artery aneurysrn（RAA）. Methods The clinical data of 5 patients who diagnosed for RAA were analyzed retrospectively. One was male and the other 4 cases were female with mean age of 35 years old. Diameter range of RAA was 0.5-9.0 cm （mean 3.5 cm）. Three case were solitary RAA and 2 case was bilateral. Clinical manifestations included flank pain and hematuria in 2 cases, abdominal pain with hemorrhagic shock in 1 case and hypertension in 1 case. Color ultrasonic diagnosed parapelvic cyst with calcification, hydronephrosis and RAA. All 5 cases were confirmed by angiography of renal artery. Results A solitary renal with multiple RAA burst died 5 days after dignosed without surgi- cal treatment. One giant RAA which diameter was 9.0 cm was undergone embolism of renal artery and then performed nepbrectomy. The other 3 cases underwent super selective renal artery embolization, endovascular treatment with stent-graft and selective renal artery ligation. Renal-sparing cases were followed-up for 10, 12 and 24 months without recurrence. Conclusions If RAA is no more than 2 cm in diameter, the watchful waiting is feasible. The operation or endovascular treatment should be taken according to patient situation, symptom, renal function, complication and condition of RAA such as size, number and location.