肾动脉栓塞治疗肾脏疾病(附102例报告)

Renal artery embolization for the treatment of renal diseases (report of 102 cases)

目的 研究选择性或超选择性肾动脉栓塞对肾肿瘤、肾脓肿和肾出血性疾病等的治疗方法及效果。 方法 采用Seldinger法经皮穿刺行股动脉插管 ,以明胶海绵为主要栓塞材料 ,选择性肾动脉栓塞治疗肾癌6 3例、肾脓肿 4例、错构瘤 9例、外伤性肾破裂 2 3例、及 1例体外冲击波碎石后和 2例肾实质切开取石术后严重持续血尿患者 ,其中 6 0例肾癌及 4例肾脓肿栓塞后 2～ 5d(平均 3d)行手术治疗 ,3例晚期肾癌行单纯栓塞治疗 ;9例错构瘤栓塞用无水酒精和 (或 )明胶海绵 ,2 6例出血性疾病采用明胶海绵或 (和 )自体凝血块等。 结果 6 0例肾癌、4例肾脓肿栓塞后体积缩小、肾周水肿带明显、出血少 ;3例晚期肾癌行单纯栓塞治疗后 1例已存活 5年 ,2例存活 6～ 9个月 ,2 6例肾出血性疾病除 1例外伤性肾破裂改行手术外 ,余均经栓塞治愈 ,随访 1个月～ 18年 ,除 1例IVU未显影、1例有轻微肾萎缩外 ,其余均正常。 结论 肾动脉栓塞是治疗肾脏疾病的一种安全、有效的方法 ,并发症少、能最大限度保留肾脏。

Objective To study the methods and efficacy of selective or superselective renal artery embolization for renal neoplasms,abcesses and bleeding. Methods Sixty cases of renal carcinomas and 4 cases of abcesses were all treated with selective renal artery embolization before surgery,and 3 cases of advanced renal carcinomas were treated with selective renal artery embolization alone.Embolization materials for carcinoma and abcesses were mainly gelfoam.Nine cases of renal angiomyolipomas,23 of traumatic renal hemorrhages,1 undergoing extracorporeal shock-wave lithotripsy (ESWL) and 2 nephrolithotomy,all of whom had severe hematuria,were treated with selective or superselective renal segment artery embolization.Embolization materials for hemorrhages were mainly self-blood clots and(or) gelfoam,and the materials for angiomyolipoma were pure alcohol and(or) gelfoam. Results The sizes of carcinomas and abcesses were decreased in all of the 60 cases of renal carcinomas and 4 cases of renal abcesses.The edema around the carcinomas and abcesses became obvious,and bleeding was reduced,which were convenient for operation and prolonged survivals.All the renal bleeding were cured with selective or superselective renal artery embolization except for one traumatic case treated by operation for continuous bleeding.All these cases were followed up for 1 month to 18 years.One case had mild atrophy of kidney and in one case IVU didn't develop.All the others were in good condition. Conclusions Selective or superselective renal artery embolization is a safe,effective approach with less complications and most probability to preserve the diseased kidney. Renal artery embolization as a valuable treatment should be studied and widely applied.