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目的 分析非肿瘤性肾动静脉畸形或瘘引起肾出血节段性肾动脉栓塞治疗的方法及疗效 ,探讨栓塞后肾脏再出血的原因及处理措施。方法 4例肾出血患者 ,其中 2例先天性肾动静脉畸形 (AVM) ,2例肾穿刺后并发肾动静脉瘘 (AVF)。经股动脉插管行肾动脉及其分支造影 ,用明胶海绵、钢丝圈或无水酒精超选择性栓塞病变血管。结果 4例畸形血管均闭塞 ,出血停止 ,全部病例在栓塞后无严重并发症发生 ;1例先天性AVM病人用钢丝圈及明胶海绵栓塞 8个月后再出血 ,经无水酒精再次栓塞后出血停止 ,随访 9个月无再出血。结论 肾动脉造影是诊断肾脏AVM和AVF的可靠方法 ;节段性肾动脉栓塞术是治疗肾脏AVM和AVF有效、安全的微创性手术 ;少数病例再发出血 ,可能与栓塞剂类型的选择和病变的特点有关 ,需应用永久性栓塞剂或多种栓塞剂联合治疗 ,甚至外科手术处理。
Objective To analyze the method and efficacy of non-neoplastic renal arteriovenous malformation (FMN) or fistula-induced segmental renal artery embolization (JFR) in renal hemorrhage and to explore the causes and treatment of renal rebleeding after thromboembolism. Methods Four patients with renal hemorrhage, including 2 cases of congenital renal arteriovenous malformation (AVM) and 2 cases of renal arteriovenous fistula (AVF) after renal puncture. The femoral artery catheterization of renal artery and its branches angiography, gelatin sponge, traveler or ethanol super selective embolization of vascular disease. Results 4 cases of abnormal blood vessels were occluded, bleeding stopped, all cases without serious complications after embolization; 1 case of congenital AVM patients with wire ring and gelatin sponge embolism after 8 months and then bleeding, rehydration after dehydration with anhydrous alcohol Stop, follow-up 9 months without further bleeding. Conclusions Renal artery angiography is a reliable method for the diagnosis of AVM and AVF in the kidney. Segmental renal artery embolization is an effective and safe minimally invasive surgery for the treatment of AVM and AVF in the kidney. In a few cases, hemorrhage may occur, which may be related to the choice of embolic agent type and The characteristics of lesions related to the need to apply permanent embolic agent or a combination of embolic agents, and even surgical treatment.