肾脏穿刺活检术所致肾血管损伤的血管内栓塞治疗

Transcatheter Endovascular Embolization of Biopsy Related Renal Vascular Injuries

目的 评价介入技术治疗肾脏穿刺活检术所致肾血管损伤的安全性和疗效。资料与方法 对7例因肾脏穿刺活检术所致肾血管损伤患者进行了超选择性肾动脉栓塞治疗。栓塞材料用微型钢丝圈6例，普通钢丝圈1例，同时用聚乙烯醇微球3例。结果 选择性肾动脉造影显示肾实质内动静脉瘘4例，对比剂外溢2例，肾内假性动脉瘤1例。栓塞成功率为100％。治疗结束时复查造影显示异常血管消失，正常分支保留。5例失血明显者，栓塞后经给予补充血容量，失血症状迅速改善；腰痛剧烈患者，术后2～5d腰痛消失；血尿7例，术后2～7d消失。术后原有肾功能不全加重2例，新出现肾功能不全1例，其中1例接受血液透析治疗。超声复查显示肾周围血肿于2～3个月逐渐吸收。随访10～68个月（平均36个月），2例死于原发疾病（慢性肾功能衰竭和淋巴瘤各1例），5例健在，未再针对肾脏损伤进行外科或介入治疗，未再发生出血，肾功能测定属正常范围。结论 经导管选择性肾动脉分支栓塞术是治疗肾脏穿刺活检术所致肾血管损伤的安全有效方法。

Objective To evaluate the efficacy and safety of the interventional techniques for treatment of biopsy-related renal injury. Materials and Methods 7 patients with biopsy-related renal vascular injuries were treated with superselective arterial embolisation. The embolization devices were microcoils in 6 patients and standard stainless steel coils in 1 patient, associated with polyvinyl alcohol particles （PVA） in 3 cases. Results Renal angiogram revealed the intra-renal arteriovenous fistula in 4 cases, the contrast media extravasation in 2 patients, and an intrarenal pseudoaneurysm in 1 patient. The technical success （100%） of the arterial embolisation was achieved in all 7 cases in a single session. Angiography documented complete obliteration of the abnormal vessels without other major intrarenal arterial branch occlusion after embolization. 5 patient with hemodynamically compromise experienced immediate relief of their blood less related symptoms, and eases with severe flank pain were relieved in 2 ～ 5 days after embolization. Hematuria in 7 patients were disappeared in 2 ～ 7 days after the embolization. 1 patient was suffered acute renal main artery thrombotic occlusion immediately after the embolization, and he was successfully treated with local thrombolysis. The renal function was worse after the procedures in 3 cases, including transient worse （ n = 2） or developed new （ n = 1 ） renal dysfunction. 1 of them required hemedialysis. The patients with perirenal hematoma were disappeared confirmed by ultrasonography in 2 ～ 3 months after the procedures. Follow-up time ranged from 10 ～ 68 months （mean 36 months）, 2 patients died of primary the renal disease（chronic renal disfunction and lymphnoma 1 case respectively）, 5 patients were still alive without further intervention, and both re-bleeding and deterioration of renal function did not occur. Conclusion Transcatheter embolization is a safe and effective endovascular technique to treat biopsy-related renal vascular injuries.