摘要
目的探讨电解可脱式弹簧圈瘤腔栓塞术在多种原因所致移植肾吻合口假性动脉瘤介入治疗中的应用和技术要点，评价其可行性和疗效，为处理移植肾血管并发症和提高移植肾长期存活率提供经验。方法回顾性分析2012年至2015年收治的9例临床和影像学检查确诊为移植肾吻合口假性动脉瘤患者的介入诊疗资料。9例患者移植肾血管吻合方式均为移植肾动脉一右侧骼外动脉端侧吻合，根据动脉瘤位置特殊均选择电解可脱式弹簧圈瘤腔栓塞术，并视不同情况辅以支架植入术。术后定期复查实验室检查和影像学检查，综合评价治疗效果。结果9例移植肾吻合口假性动脉瘤瘤腔均成功完全栓塞。术后随访3-21个月，平均12个月，复查实验室检查示血清肌酐（SCr）值、尿常规等未见明显异常；影像学复查示弹簧圈及支架无移位，未见假性动脉瘤残留或复发，移植肾动脉和髂外动脉保持通畅，未出现移植肾或下肢缺血等并发症。结论对于因位置特殊不适合常规载瘤动脉栓塞术和覆膜支架瘤腔隔绝术治疗的移植肾吻合Vl假性动脉瘤患者，采用电解可脱式弹簧圈瘤腔栓塞术可以完全栓塞瘤腔，同时保持移植肾动脉和髂外动脉通畅。该治疗方法微创、安全有效，一定程度上可代替外科手术，但远期疗效尤其是复发情况有待进一步观察。
Objective To investigate the application of embolization therapy with guglielmi detachable coil （GDC） in treating transplanted renal anastomotic pseudoaneurysm caused by different reasons, to discuss its technical key points and to evaluate its feasibility and efficacy, so as to provide experience in dealing with transplanted renal vascular complications and in improving long-term survival rate. Methods The interventional diagnosis and treatment data of 9 patients with transplanted renal anastomotic pseudoaneurysm confirmed by clinical and imaging examinations, who were admitted to authors＇ hospital during the period from 2012 to 2015, were retrospectively analyzed. End-to-side anastomosis between transplanted renal artery and right external iliac artery was carried out in all 9 patients. Because of the special location of pseudoaneurysms, GDC was sued to perform the embolization in all patients, and stent implantation was employed when needed. After the treatment laboratory tests and imaging study were regularly reexamined. The curative effect was comprehensively evaluated. Results Successful embolization of anastomotic pseud- oaneurysm was accomplished in all 9 patients. The patients were followed up for 3-21 months with a mean of 12 months. Laboratory examinations showed that Scr levels and routine urine tests were normal; imaging examination revealed that neither displacement of spring coil and stent nor residual or recurrence of pseudoaneurysm occurred. The transplanted renal artery and external iliac artery remained open, and no complications such as ischemia of the transplanted kidney or lower limb were observed. Conclusion For the treatment of transplanted renal anastomotic pseudoaneurysms that are not suitable for conventional embolization of parent artery as well as not for aneurysmal cavity isolation therapy with covered stent because of their special locations, embolization therapy with GDC can completely occlude the aneurysm cavity, meanwhile, this technique can keep the renal artery and external iliac artery unobstructed. This treatment is minimally invasive, safe and effective, and it can replace the surgery in a certain extent, although its long- term efficacy, especially the recurrence of aneurysm, needs to be further clarified.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第1期19-23,共5页
Journal of Interventional Radiology
关键词
移植肾
假性动脉瘤
弹簧圈
介入治疗
transplanted kidney
pseudoaneurysm
steel coil
interventional treatment
