CAJ | 학술논문

目的探讨肾动脉瘤(renal artery aneurysm,RAA)腔内介入治疗的方法及疗效.方法回顾性分析2009年1月至2014年4月17例确诊为RAA并行介入治疗患者的临床资料.男7例,女10例.年龄20 ～ 67岁,平均(46.4±10.3)岁.体检发现5例,表现为腹痛和腰痛各4例,表现为间断性肉眼血尿2例,表现为乳糜尿和少尿各1例.多发9例,单发8例.17例共31个动脉瘤,其中真性动脉瘤26个,假性动脉瘤5个;囊状动脉瘤17个,纺锤形或梭形、不规则形、实质内动脉瘤各4个,夹层动脉瘤2个.8个动脉瘤位于肾动脉主干,19个位于肾动脉二级、三级分支,4个位于肾实质内.6例行瘤腔栓塞+载瘤动脉栓塞术,4例行瘤腔栓塞术,3例行载瘤动脉栓塞术,2例行裸支架辅助瘤腔栓塞术,1例行覆膜支架置入术,1例双侧RAA行右侧裸支架辅助瘤腔栓塞术+左侧瘤腔栓塞术. 结果本组17例中16例一次手术成功.随访3～53个月,平均23个月,无严重并发症或死亡病例.术后1周3例尿潜血阳性者转为阴性.术后1个月12例的肉眼血尿、腹痛、腰背痛、发热等首发症状消失或明显减轻.术后3～12个月,实验室检查示SCr、BUN、尿常规等未见明显异常.复查超声或CT动脉造影示16例支架及弹簧圈无移位,8例载瘤动脉通畅,未见动脉瘤复发或瘤腔扩大.结论 RAA的腔内介入治疗创伤小、安全、有效.应根据RAA的具体情况制定手术方案.
목적 탐토신동맥류(renal artery aneurysm,RAA)강내개입치료적방법급료효.방법 회고성분석2009년1월지2014년4월17례학진위RAA병행개입치료환자적림상자료.남7례,녀10례.년령20 ～ 67세,평균(46.4±10.3)세.체검발현5례,표현위복통화요통각4례,표현위간단성육안혈뇨2례,표현위유미뇨화소뇨각1례.다발9례,단발8례.17례공31개동맥류,기중진성동맥류26개,가성동맥류5개;낭상동맥류17개,방추형혹사형、불규칙형、실질내동맥류각4개,협층동맥류2개.8개동맥류위우신동맥주간,19개위우신동맥이급、삼급분지,4개위우신실질내.6례행류강전새+재류동맥전새술,4례행류강전새술,3례행재류동맥전새술,2례행라지가보조류강전새술,1례행복막지가치입술,1례쌍측RAA행우측라지가보조류강전새술+좌측류강전새술. 결과 본조17례중16례일차수술성공.수방3～53개월,평균23개월,무엄중병발증혹사망병례.술후1주3례뇨잠혈양성자전위음성.술후1개월12례적육안혈뇨、복통、요배통、발열등수발증상소실혹명현감경.술후3～12개월,실험실검사시SCr、BUN、뇨상규등미견명현이상.복사초성혹CT동맥조영시16례지가급탄황권무이위,8례재류동맥통창,미견동맥류복발혹류강확대.결론 RAA적강내개입치료창상소、안전、유효.응근거RAA적구체정황제정수술방안.
Objective To evaluate the safety and efficacy of interventional procedure for treating the renal artery aneurysm (RAA).Methods From Jan 2009 to Apr 2014,17 patients,who were diagnosed as RAA and accepted the interventional therapy,were reviewed in our hospital.The mean age in those patients,including 7 males and 10 females,was (46.4±10.3) years old (range from 20 to 67 years old).The related symptoms included backache in 4 cases,abdominal pain in 4 cases,intermittent hematuria in 2 cases,chyluria in one case,oligouria in one case.9 cases were diagnosed as multiple RAA and 8 cases were confirmed as signle cases.In 17 cases,31 aneurysms were found,including 26 true aneurysms,5 pseudoaneurysums,17 sacculated aneurysms,4 spindle-like aneurysms,4 irregular shape aneurysms,4 parenchyma aneurysm and 2 dissecting aneurysm.8 aneurysms located in the main renal artery,19 aneurysms located in the branch of renal artery,4 aneurysums located in the renal parenchyma.Intracavitary coil embolization was used in 4 patients.We carried out parent artery embolization in 3 patients.A combination of the former techniques was performed in 6 cases.Covered stent placement was operated in one case.Combination of the intracavitary coil embolization and nude stent placement were performed in 2 patients.We used two techniques in one patient with multiple artery aneurysms in both sides.Results The interventional treatment of RAAs succeed at the first operation in 16 of 17 patients.17 cases were followed-up from 3 to 53 months (mean 23 months).No severe complications or death cases occurred in this study.Urine occult blood in 3 patients turned to negative after one week.Primary symptoms such as gross hematuria,abdominal pain,lumbodorsalgia,fever vanished or obviously eased after a month.Laboratory tests showed that normal level in SCr,BUN,routine urinalysis 3 months,6 months and 1 year later.No tendency of stent and coil stent shifting was found in 16 patients and the parent arteries were patent in 8 cases,with reexamination bv ultrasonic or computed tomography angiography (CTA).Conclusions Interventional techniques are minimally-invasive,safe and effective methods for treating the RAAs.