急性肾脏出血合并肾功能不全的超选择性肾动脉栓塞:临床疗效和安全性分析

Superselective transcatheter renal arterial embolization for acute renal bleeding in patients with renal insufficiency:its clinical efficacy and safety

目的探讨超选择性肾动脉栓塞在治疗急性肾脏出血合并肾功能不全患者的疗效及并发症,评价其对肾功能的影响。方法回顾性分析2000年1月至2009年12月接受肾动脉栓塞并有完整临床及影像学资料的13例合并肾功能不全的急性肾出血患者,重点分析栓塞的临床疗效、栓塞前后肾功能变化及栓塞范围和并发症的关系。结果所有患者均获成功栓塞,技术成功率100%,平均栓塞范围22%。术后3d患者血红蛋白、红细胞压积、血压、心率有所恢复,前后相比差异均有统计学意义(P均<0.01)。与术前相比,术后3d肌酐水平增高(P=0.000),尿素氮轻度降低(P=0.346),术后7d,肌肝呈轻度降低(P>0.05),BUN则降低明显(P=0.011)。5例出现栓塞后综合征,1例肾功能进行性恶化,最后接受透析治疗。发生并发症患者的栓塞范围较大(U=1.500,P=0.006)。结论超选择性肾动脉栓塞治疗急性肾脏出血合并肾功能不会明显加重肾功能恶化,控制栓塞范围是减少并发症的最重要措施。

Objective To discuss the clinical efficacy and complications of superselective renal arterial embolization in treating acute renal arterial bleeding in patients with renal insufficiency,and to evaluate the influence of the treatment on the renal function.Methods During the period of January 2000 December 2009,superselective renal arterial embolization was performed in our institution for acute renal bleeding in 13 patients with renal insufficiency.The complete clinical and imaging materials of all patients were properly collected.The clinical effectiveness,the renal function,the extent of embolization and the complications were observed and the relationship between each other was analyzed.Results The embolization procedure was successfully completed in all patients with a technical success rate of 100%.The mean embolized territory was 22% of a single kidney.Three days after the procedure,the hemoglobin level,hematocrit,blood pressure and heart rate were considerably improved in all patients.Compared to the corresponding preoperative data,all the differences were statistically significant （P 0.01）.Three days after the procedure,the creatinine level was slightly elevated （P=0.000） and the blood urea nitrogen was slightly decreased （P=0.346）.Seven days after the treatment,the creatinine level was slightly decreased （P 0.05）,while the blood urea nitrogen was markedly decreased （P=0.011）.Post embolization syndrome occurred in 5 patients and progressive aggravation of the renal function was observed in one patient,who had to receive hemodialysis finally.The embolized territory in patients occurring complications was larger than that in patients without occurring complications （U=1.500,P=0.006）.Conclusion Superselective renal arterial embolization is an effective and safe treatment for acute renal arterial bleeding in patients with renal insufficiency,the therapy will not significantly worsen the renal function.Appropriate and reasonable extent of embolization,as small as possible,is the key point for reducing the complications.