超选择性肾动脉栓塞治疗严重肾出血的疗效评价

The clinical value of super-selective renal arterial embolization for severe renal hemorrhage

目的探讨超选择性肾动脉栓塞术治疗经保守治疗无效的严重肾出血的临床价值。方法回顾性分析111例采用超选择性肾动脉栓塞术治疗的严重肾出血患者的临床资料、栓塞方式、治疗和随访结果。结果本组患者治疗后效果满意,无严重并发症发生。一次栓塞成功106例(成功率为95.5%),术后第1～4d肉眼血尿消失。2例栓塞后休克得以控制,顺利实施了外科手术。3例栓塞后再发出血,经第2次栓塞血止。术后随访92例,平均37.4个月,患肾功能得到了最大程度的保护。结论超选择性肾动脉栓塞术是严重肾出血的一种安全有效的治疗方法,可同时保护健康的肾实质和肾功能。

Objective To evaluate super-selective renal arterial embolization （SRAE） in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management. The clinical data, the way of embolization, the medication and the follow-up findings were retrospectively analyzed. Results Excellent results were obtained in all patients after SRAE and no serious complications occurred. The technical successful rate with single session was 95.5% （106 / 111）. Gross hematuria disappeared within 1-4 days after the treatment. Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled. Three patients had a recurrence of hematuria, the blood urine subsided after SRAE was employed again. A follow-up with a mean period of 37.4 months was carried out in 92 patients, and the follow-up checkups showed that the renal function was well preserved in all patients. Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage, it can maximally preserve the healthy renal parenchyma as well as the renal function. Therefore, this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.