Department of Radiology, Beaumont Hospital, and Division of Population and Health Sciences, Royal College of Surgeons in Ireland (FD), Dublin, Ireland.
Department of Radiology, Beaumont Hospital, and Division of Population and Health Sciences, Royal College of Surgeons in Ireland (FD), Dublin, Ireland.
J Urol. 2015 Sep;194(3):635-9. doi: 10.1016/j.juro.2015.04.081. Epub 2015 Apr 25.
Transarterial embolization is increasingly used in the management of renal angiomyolipoma. The level of evidence establishing the safety and efficacy of transarterial embolization has not increased in parallel.
Using the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) criteria a systematic review of transarterial embolization of angiomyolipoma was performed to establish procedural safety and efficacy. A MEDLINE® PubMed® search revealed 1,739 publications, of which 31 studies met eligibility criteria.
A total of 524 cases of transarterial embolization of angiomyolipoma were included in analysis. Self-limiting post-embolization syndrome developed following 35.9% of embolizations and further morbidity developed in 6.9%. No procedural mortality was reported. At a mean followup of 39 months the mean size reduction was 3.4 cm (-38.3% of angiomyolipoma diameter). Unplanned repeat embolization or surgery was required in 20.9% of cases during this period. The most frequent indications for repeat procedures included angiomyolipoma revascularization in 30.0% of cases, unchanged or increasing size in 22.6%, refractory or recurring symptoms in 16.7% and representation with acute retroperitoneal hemorrhage in 14.3%. Treatment included a combination of 2 or more embolic agents in 46.8% of cases, ethanol monotherapy in 41.7%, coil monotherapy in 6.2% and foam or microparticle monotherapy in 5.2%.
Transarterial embolization of angiomyolipoma demonstrates low rates of mortality and serious complications. Re-treatment rates and size reduction at a mean followup of 39 months are presented. Longitudinal data assessing long-term size reduction and re-treatment rates are lacking. Recommendations guiding the indications for transarterial embolization and clear followup require further longitudinal data.
经动脉栓塞术在肾血管平滑肌脂肪瘤的治疗中应用越来越广泛。但经动脉栓塞术的安全性和疗效的证据水平并没有同步提高。
使用 MOOSE（观察性研究的荟萃分析）标准，对血管平滑肌脂肪瘤的经动脉栓塞术进行了系统评价，以确定其程序安全性和疗效。通过 MEDLINE® PubMed®搜索，共发现 1739 篇文献，其中 31 项研究符合入选标准。
共纳入 524 例血管平滑肌脂肪瘤的经动脉栓塞术。35.9%的栓塞后出现自限性栓塞后综合征，进一步发生并发症的比例为 6.9%。无手术相关死亡病例。平均随访 39 个月后，血管平滑肌脂肪瘤的平均体积缩小 3.4cm（占血管平滑肌脂肪瘤直径的-38.3%）。在此期间，20.9%的病例需要进行计划外的重复栓塞或手术。再次治疗的最常见指征包括血管平滑肌脂肪瘤再血管化占 30.0%，大小不变或增大占 22.6%，难治性或复发性症状占 16.7%，急性腹膜后出血占 14.3%。治疗方法包括 2 种或以上栓塞剂联合应用占 46.8%，乙醇单药治疗占 41.7%，单纯弹簧圈栓塞治疗占 6.2%，单纯泡沫或微球栓塞治疗占 5.2%。
经动脉栓塞术治疗血管平滑肌脂肪瘤的死亡率和严重并发症发生率均较低。本研究报道了平均随访 39 个月时的再治疗率和体积缩小率。目前缺乏评估长期体积缩小和再治疗率的纵向数据。指导经动脉栓塞术适应证和明确随访的建议需要进一步的纵向数据。
