CAJ | 학술논문

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。
목적평개신혈관평활기지방류파렬출혈급진하행선택성신동맥전새술적안전성화유효성。방법2007년4월-2012년10월，12례경B초、CT혹MRI학진적신혈관평활기지방류환자，좌신5례（기중2례우신유엄중경조성신병），우신4례（기중1례좌신이절제），쌍신3례。10례돌발요배부혹복부동통、신주혈종，2례출현혈뇨。급진행선택성신동맥조영화전새술，전새제용평양매소전화유유제、PVA과립화탄황권。술후채용CT수방료해종류대소변화급전새효과。결과12례환자진행료14차치료，조영발현종류구역대량문란혈관급동맥류형성，전새후조영복사，종류이상혈관상소실，종류내재류동맥폐새。술후림상증상개선，출혈정지，신공능무명현수손，무엄중병발증출현。수방3개월～5년6개월，환자무출현복통、혈뇨등종류파렬출혈상관증상，복사CT종류체적유소축소，축소이혈관평활기성분위주，지방성분변화교소。결론선택성신동맥전새치료신혈관평활기지방류급성파렬출혈，능유효공제출혈병능최대한도보호정상신조직，기대독신혹대측신공능명현수손환자우위중요。종류내혈관평활기성분대전새치료십분민감，수방기중원기효과량호，응작위급진출혈적수선치료방법。
Objective To evaluate the efifcacy 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 right kidney), and four in the right with one the left kidney resection and three patients 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 ifrst management of RAML with bleeding.