肾动静脉瘘的诊断与治疗

Diagnosis and treatment of intrarenal arteriovenous fistula

目的 探讨肾动静脉瘘的诊断和治疗方法。 方法 回顾性分析 8例肾动静脉瘘患者的临床资料。其中原发性动静脉瘘 5例 ,继发于肾肿瘤 2例、外伤 1例。 结果 2例肾肿瘤者 1例行肾切除术 ,1例因肿瘤转移仅行化疗。 6例行经皮超选择性肾动脉栓塞治疗。随访 6～ 6 0个月 ,1例栓塞失败者行肾切除术 ,1例瘘管再通者行二次栓塞治疗。一次栓塞成功者 4例。 结论 影像学检查是诊断肾动静脉瘘的主要手段 ,除恶性肿瘤外经皮超选择性肾动脉栓塞是治疗肾动静脉瘘的首选方法。

Objective To elucidate the diagnosis and treatment for intrarenal arteriovenous fistula. Methods Clinical data of 8 patients with intrarenal arteriovenous fistula were analysed retrospectively.The fistula was primary in 5 and secondary in 3.6 patients underwent percutaneous superselective renal artery embolization,and have been followed up for 6 months to 5 years. Results 1 unsuccessful embolization led to nephrectomy,whereas the other 5 embolizations were successful.Only 1 patient need a second embolization because of recanalization. Conclusions Intrarenal arteriovenous fistula is rare.Color ultrasound and MRI can be used to diagnose intrarenal arteriovenous fistula noninvasively,but renal arteriography is still the best method.Except for malignant renal tumor,percutaneous superselective renal artery embolization is the first choice for treatment with minor injury and complications.