肾血管平滑肌脂肪瘤的CT诊断及其介入治疗

发布时间：2019-02-21 13:02

【摘要】：目的：探讨肾血管平滑肌脂肪瘤(Renal angiomyolipoma, RAML) CT影像学表现及超选择性经肾动脉栓塞术(Transrenal artery embolization, TRAE)在其治疗中的应用。材料与方法：收集2010年6月-2013年12月行CT平扫及增强检查的患者102例。其中经病理证实肾血管平滑肌脂肪瘤的患者50例,男11例,女39例,年龄22-73岁,平均47.24岁。以病理结果为金标准,根据有无误诊分为两组,观察CT诊断RAML的敏感性。另外52例患者经CT平扫及增强检查诊断为肾血管平滑肌脂肪瘤,其中男13例,女39例；年龄20-69岁,平均45.8岁；急诊破裂出血15例,腰部疼痛31例,体检发现巨大肿块6例,均行数字减影血管造影及超选择性经肾动脉栓塞术。结果：50例经病理证实肾血管平滑肌脂肪瘤患者,其中48例CT正确诊断为肾AML,2例CT误诊为肾脏肿瘤,CT对肾AML的诊断敏感性96%。发生于左肾23例,右。肾25例,双。肾2例。诊断正确的一组48例患者,CT平扫,肿块见典型的脂肪低密度影和软组织密度影混杂,软组织部分平扫CT值15-60Hu,增强扫描动脉期明显强化,CT值50-110Hu,静脉期强化减退,延迟期强化不明显；脂肪部分,平扫CT值-120--10Hu,动脉期、静脉期及延迟期均未见强化,肿块平扫时平均CT值-5.6Hu,增强动脉期平均CT值23.7Hu。误诊的一组2例,误诊为肾脏肿瘤,CT平扫见肿块等或稍低密度,未见明显低密度影,平扫CT值15～65Hu,平均CT值29.3Hu,增强扫描动脉期肿瘤明显强化,CT值60～130Hu,平均CT值72.3Hu,静脉期肿瘤强化减退,延迟期肿瘤强化不明显。两组患者平扫及增强后动脉期平均的CT值相比,均有极显著性差异(P0.01)。52例超选择性经肾动脉栓塞术患者,发生于左肾24例,其中孤立肾3例,右肾19例,其中孤立肾3例,双肾9例；所有患者肾动脉造影均显示肿瘤部位不同程度的肿瘤染色,部分突出于肾影外,肿瘤部位血管紊乱,呈螺旋状,肿瘤多为单支肾内分支动脉供血,瘤体血管上可见有点状或串珠状动脉瘤存在。破裂出血的15例患者,动脉期还可见分支动脉造影剂外溢。栓塞术后,所有患者造影可见肿瘤染色消失,靶血管闭塞,I临床症状减轻,破裂出血的患者血压回升,血尿消失,术后未出现明显并发症,随诊回访3-6月,肿瘤大小都有不同程度的缩小。结论：cT可准确的诊断RAML。通过超选择性经肾动脉栓塞治疗能有效的控制肿瘤生长,防治出血并能最大限度保护正常肾组织。
[Abstract]:Objective: to investigate the (Renal angiomyolipoma, RAML) CT imaging findings of renal angiomyolipoma and the application of superselective transrenal artery embolization (Transrenal artery embolization, TRAE) in the treatment of renal angiomyolipoma. Materials and methods: 102 cases of CT plain scan and enhanced examination from June 2010 to December 2013 were collected. There were 50 cases of renal angiomyolipoma confirmed by pathology, including 11 males and 39 females, aged 22-73 years with an average age of 47.24 years. The sensitivity of CT in the diagnosis of RAML was observed by using pathological results as gold standard and divided into two groups according to misdiagnosis. The other 52 patients were diagnosed as renal angiomyolipoma by CT plain scan and contrast-enhanced examination, including 13 males and 39 females, aged 20-69 years with an average of 45.8 years old. 15 cases of emergency rupture hemorrhage, 31 cases of lumbar pain, 6 cases of massive mass were detected by physical examination. All cases were performed digital subtraction angiography and superselective transrenal artery embolization. Results: of the 50 cases of renal angiomyolipoma confirmed by pathology, 48 cases were correctly diagnosed as renal AML,2 by CT and CT was misdiagnosed as renal tumor. The sensitivity of CT to the diagnosis of renal AML was 96%. It occurred in 23 cases of left kidney, right side. Kidney 25 cases, double. Kidney 2 cases. In a group of 48 patients diagnosed correctly, CT plain scan showed typical low density fat and soft tissue density mixed, CT value of soft tissue was 15-60 Hu. enhanced arterial phase obviously enhanced, CT value 50-110 Hu. and venous phase enhancement decreased. The enhancement of delayed period was not obvious; In the fat part, the CT value of plain scan was-120 渭 10 Hu.No enhancement was found in arterial phase, venous phase and delayed phase. The average CT value in plain scan of mass was-5.6 Huand the average CT value in enhanced arterial phase was 23.7Hu.In the fat part, the mean CT value in contrast-enhanced arterial phase was 23.7 Hu. 2 cases were misdiagnosed as renal tumor, CT showed mass or low density, no obvious low density, plain scan CT value was 15 ~ 65 Hu. average CT value was 29.3Hu. enhanced arterial phase tumor was obviously enhanced, CT value was 60 ~ 130Hu. The mean CT value was 72.3 Hu. the enhancement of tumor in venous phase was decreased, but that in delayed phase was not obvious. There was a significant difference in the mean CT values between the two groups in both plain scan and enhanced posterior arterial phase (P0.01). 52 cases of superselective transrenal artery embolization occurred in 24 cases of left kidney, including 3 cases of solitary kidney and 19 cases of right kidney. There were 3 cases of isolated kidney and 9 cases of double kidney. Renal arteriography in all patients showed different degree of tumor staining, partly protruding outside the shadow of the kidney, the tumor site vascular disorder, spiral shape, the tumor is mostly a single intra-renal branch of blood supply, Punctate or beaded aneurysms were found in the blood vessels of the tumor. In 15 patients with ruptured hemorrhage, branch arterial contrast agent spills were also found in arterial phase. After embolization, the tumor staining disappeared, the target vessel occluded, the clinical symptoms of I alleviated, the blood pressure increased and hematuria disappeared in the patients with ruptured hemorrhage, and no obvious complications occurred after the embolization. The patients were followed up for 3 months and 6 months, and the patients were followed up for 3 months and 6 months. The size of the tumor shrinks to varying degrees. Conclusion: cT can accurately diagnose RAML.. Superselective renal artery embolization can effectively control tumor growth, prevent bleeding and protect normal renal tissue.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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