介入栓塞治疗肾动静脉畸形(瘘)11例报道并文献复习

Interventional embolization of renal arteriovenous malformation/fistula:a report of 11 cases and literature review

目的通过分析肾动静脉畸形影像学征象并通过介入栓塞治疗,提高肾动静脉畸形的诊断和治疗水平。方法回顾性分析2004年4月至2014年12月期间在南京大学医学院附属鼓楼医院行肾动脉造影和选择性栓塞治疗的11例肾动静脉畸形患者的临床资料。通过呈现典型的栓塞前后影像特点,对常见栓塞方法及疗效进行讨论。结果 11例肾动静脉畸形患者的影像特点可分为2类:1一个或多个小动脉和一个或多个引流静脉之间成迂曲血管团状病灶,共6例;2单个动脉和扩张静脉间交通,肾动静脉之间直接形成瘘而无畸形血管团,5例。其中治疗后1例患者在栓塞8d后复发,行肾切除后血尿消失,对侧肾功能代偿正常;1例患者在栓塞1d复发后加用无水乙醇,随访6年无复发。结论选择性肾动脉造影和栓塞术是肾动静脉畸形主要的诊断和治疗方法,组合使用栓塞材料较使用单一栓塞材料临床效果更好,但仍需要密切随访。

Objective To explore the angiographic manifestations and interventional treatment of renal arteriovenous malformations.Methods Clinical data of 11 patients with renal arteriovenous malformations treated in Nanjing Drum Tower Hospital during Apr.2004 and Dec.2014 were reviewed.The angiographic manifestations and common embolization were analyzed.Results All of the 11 cases were diagnosed as renal arteriovenous malformations by means of angiography.According to the image manifestations,these cases were classified into two types：1A nidus of tortuous channels between one or more arteries/arterioles and one or more draining veins in 6 cases;2High discharge shunt without deformed branches in 5 patients.One case recurred 8 days after embolization and received nephrectomy,and then the function of the contralateral kidney returned normal.Another case recurred one day after embolization,received a second alcohol embolization,and did not recur after a follow-up of 6 years.Conclusions Superselective renal angiography and embolization are the most important and effective tools for the diagnosis and treatment of renal arteriovenous malformations.Combined use of materials produces better clinical effect than a single material.All patients need close follow-up.