经皮肾镜取石术术后迟发出血的动脉造影与栓塞治疗

The DSA performance of delayed hemorrhage after percutaneous nephrolithotomy lithotomy and embolization therapy

目的评价数字减影血管造影及超选择性动脉栓塞在诊断、治疗经皮肾镜取石术后迟发出血患者的临床价值。方法对18例经皮肾镜取石术后迟发出血的患者采取选择性肾动脉造影检查,明确诊断后选用明胶海绵颗粒或弹簧钢圈行超选择性动脉栓塞。结果 18例患者中17例造影阳性,其中表现:单纯假性动脉瘤6例,动静脉瘘2例,假性动脉瘤并动静脉瘘3例,片状对比剂外溢6例。17例阳性患者中16例行1次栓塞后成功止血,1例行2次栓塞后止血1,8例均治愈出院,无肾脏切除。随访6个月均未再次出血。结论经皮肾镜取石术后迟发出血在数字减影血管造影中表现典型,超选择性动脉栓塞创伤小,疗效显著,是治疗经皮肾镜取石术后迟发难以控制的出血的重要方法。

【Objective】 To evaluate the clinical value of digital subtraction angiography and superselective arterial embolization for the diagnosis and treatment in the delayed bleeding of percutaneous nephrolithotomy.【Methods】 18 cases of delayed hemorrhage of percutaneous nephrolithotomy underwent selective renal artery angiography,coils and/or gelatin sponge particles were used for superselective arterial embolization after diagnosis.【Results】 18 patients with renal artery digital subtraction angiography showed a false aneurysm in 9 cases,arteriovenous fistula in 5 cases,extravasation of contrast material in 6 cases.16 cases in 17cases underwent successful embolization once,one case was stopped bleeding after twice embolization,18 patients were cured and no case needing nephrectomy.Re-bleeding wasn＇t observed with follow-up of six months.【Conclusions】 Digital subtraction angiography has typical performance in percutaneous nephrolithotomy of delayed bleeding,superselective arterial embolization has less invasion and more effection.It is the important treatment for the delayed bleeding after percutaneous nephrolithotomy.