血尿的急诊介入栓塞治疗

Emergency interventional therapy For Hematuria PENG Jianguo

目的:评价选择性肾动脉、髂内动脉或(和)膀胱动脉栓塞治疗肾动静脉畸形(或瘘)、肾外伤及膀胱癌所致血尿的安全性和疗效。方法:回顾性分析35例因肉眼血尿行急诊肾动脉、髂内动脉或(和)膀胱动脉栓塞,采用Seldinger技术,首先行肾动脉、髂内动脉或(和)膀胱动脉DSA造影,明确靶血管利用路径图实施超选,栓塞剂根据病因分别选用无水乙醇、PVA、弹簧圈和明胶海绵或几种栓塞剂联合使用。结果:先天性肾动静脉畸形1例;医源性肾动静脉瘘2例;外伤性肾动静脉瘘2例;外伤性假性动脉瘤3例;肾挫伤与裂伤8例;侵润型膀胱癌19例。全部病例栓塞成功,栓塞治疗后异常血管征象消失,术后1～7d临床肉眼血尿症状完全消失,随访期间无严重并发症及再次血尿。结论:选择性肾动脉、髂内动脉或(和)膀胱动脉栓塞治疗肾动静脉畸形(或瘘)、肾外伤及膀胱癌所致的血尿安全、有效。

Objective：To evaluate the efficacy and safety of selective renal,pelvic and vesical arterial emboli-zation for hematuria caused by renal arteriovenous malformation or fistulae.Method：The data of 35patients with gross hematuria who were accepted emergency embolism for renal artery,pelvic artery and vesical artery were retrospectively analyzed.All cases undergone digital subtraction angiography of the renal artery,pelvic artery and vesical artery with Seldinger’s technology firstly.After identifying the target vessel,the superselective catheterization were carried out under the guiding of the pathway image.Different embolic materials including dehydrated alcohol,PVA,coils and gelatin sponge were used by solo or by joint according to the cause of the disease.Result：Congenital renal arteriovenous malformation were demonstrated by DSA in one patient,iatrogenic renal arteriovenous malformation in two patients,traumatic renal arteriovenous malformation in two pa-tients,traumatic pseudoaneurysm in three patients,contusion and laceration of kidney in 8patients and infiltrating carcinoma of bladder in 19patients.Embolization was successfully carried out in all patients.Clinical gross hematuria disappeared one to seven days after the operation.No severe complications were encountered in the follow-up.Conclusion：Selective embolization of the renal artery,pelvic artery and（or）vesical artery is safe and effective for hematuria caused by renal arteriovenous malformation or fistulae,trauma and carcinoma of bladder.