12例肾血管平滑肌脂肪瘤破裂出血的急诊肾动脉栓塞治疗

目的评价肾血管平滑肌脂肪瘤破裂出血急诊下行选择性肾动脉栓塞术的安全性和有效性。方法 2007年4月-2012年10月,12例经B超、CT或MRI确诊的肾血管平滑肌脂肪瘤患者,左肾5例(其中2例右肾有严重梗阻性肾病),右肾4例(其中1例左肾已切除),双肾3例。10例突发腰背部或腹部疼痛、肾周血肿,2例出现血尿。急诊行选择性肾动脉造影和栓塞术,栓塞剂用平阳霉素碘化油乳剂、PVA颗粒和弹簧圈。术后采用CT随访了解肿瘤大小变化及栓塞效果。结果 12例患者进行了14次治疗,造影发现肿瘤区域大量紊乱血管及动脉瘤形成,栓塞后造影复查,肿瘤异常血管床消失,肿瘤内载瘤动脉闭塞。术后临床症状改善,出血停止,肾功能无明显受损,无严重并发症出现。随访3个月～5年6个月,患者无出现腹痛、血尿等肿瘤破裂出血相关症状,复查CT肿瘤体积有所缩小,缩小以血管平滑肌成分为主,脂肪成分变化较小。结论选择性肾动脉栓塞治疗肾血管平滑肌脂肪瘤急性破裂出血,能有效控制出血并能最大限度保护正常肾组织,其对独肾或对侧肾功能明显受损患者尤为重要。肿瘤内血管平滑肌成分对栓塞治疗十分敏感,随访其中远期效果良好,应作为急诊出血的首选治疗方法。

Objective To evaluate the efficacy and safety of emergency selective arterial embolization（SAE）in renal angiomyolipoma（RAML） with rupture bleeding. Methods Twelve patients with RAML were diagnosed by ultrasonography （US）, computed tomography（CT） or magnetic resonance imaging（MRI）.Five patients had AML in the left kidney（2 of 5 with serious obstructive nephropathy in the fight kidney）, and four in the right with one the left kidney resection and three rpatients in both kidneys. All patients had symptoms of acute hemorrhage and sudden pain in abdominal or back, 2 presented hematuria. Selective renal arterial embolization has been used to control bleeding. The embolic materials included a mixture of PYM and lipidol,polyvinyl alcohol particles （PVA） and coils. Follow-up computed tomography（CT） were performed in all patients. The effectiveness of selective arterial embolization was evaluated on the basis of the area of the angiomyogenic components in the AML on initial and follow-up images and clinical improvement.Results Twelve patients underwent 14 selective arterial embolizations. The angiography showed devascularization of the tumor and aneuysm after embolization in all patients. After the procedure, renal function was normal and no serious complications occurred. During follow-up from 3 months to 66 months, the clinical symptoms of bleeding and pain were disappeared in all patients. In long-term CT follow-up（_〉12 months） in 10 patients, nearly all angiomyogenic components disappeared, but fatty components partially shrank with liquefactive necrosis in tumors. Conclusion Selective arterial embolization is an effective and safe treatment of RAML with acute ruputure and bleeding. The angiomyomatous components crucial for the prevention of bleeding were very sensitive to the embolization. It regards as the first management of RAML with bleeding.