肾动静脉畸形的数字减影血管造影术诊断及栓塞治疗的临床分析

Renal Arteriovenous Malformation:Digital Subtraction Angiography Diagnosis and Clinical Analysis of Transarterial Embolization

【目的】探讨肾动静脉畸形(rAVM)的数字减影血管造影术(DSA)诊断价值及经动脉栓塞治疗(TAE)的方法及其疗效。【方法】回顾性分析2004年10月至2009年1月期间我院5例以肉眼血尿为主要表现的rAVM患者的诊断经过以及TAE治疗的效果,术后随访10～60个月(平均38个月)。【结果】患者经DSA检查后均诊断为静脉曲张型rAVM,自发性、无痛性、全程肉眼血尿是此型rAVM的惟一临床表现。肾动脉DSA能清晰显示rAVM的畸形血管和动静脉瘘,其中1例副肾动脉供血,1例第2次DSA时出现自然消退。DSA后5例均顺利以PVA和(或)微钢圈行超选择TAE,术后栓塞肾与全肾的体积平均比为(8.51±4.84)%(范围4.52%～18.31%)。术后肉眼血尿于1h明显改善,15～48h(平均28h)内消失,随访期间未见血尿复发,无并发症。【结论】临床诊断rAVM困难,在所有影像学检查中,肾动脉DSA是诊断rAVM的金标准。PVA和(或)微钢圈TAE治疗rAVM安全、简单、微创,中远期临床疗效明确。

【Objective】To investigate the value of digital subtraction angiography（DSA）in diagnosing of renal arteriovenous malformation（rAVM）and the methods and therapeutic effect of transarterial embolization（TAE）.【Methods】Between October 2004 and January 2009 in our hospital,5 cases with rAVM causing gross hematuria were analyzed for their diagnosis process and effect of TAE,retrospectively.They were followed up for 10 to 60 months（mean 38）after the procedure.【Results】All cases were diagnosed cirsoid rAVM after renal artery DSA.Spontaneous painless gross hematuria was the only clinical manifestation of cirsoid rAVM.DSA clear demonstrated tortuously coiled small vasculars and arteriovenous fistula in all cases.One rAVM was blood-supplied by accessory renal artery.And another rAVM showed a spontaneous regression in the second DSA.Superselective TAE with polyvinyl alcohol particles（PVA）and/or micro coils after DSA was performed successfully in all patients.The mean ratio of infarcted areas-to-whole renal parenchyma was（8.51±4.84）%（range from 4.52%to 18.31%）.Hematuria lightened obviously in one hour and ceased in 15 to 48 hours（mean 28）after TAE.During the follow-up,no hematuria recurred and no complication was found.【Conclusions】It is difficult to make a definite diagnose for the rAVM.Of the imaging modalities,renal artery DSA remains the gold standard to diagnose rAVM.Superselective TAE of rAVM with PVA and/or micro coils is a safe,easy and minimally invasive technique with good mid to long-term clinical efficacy.