经皮肾镜取石术后迟发性肾出血的DSA诊断和介入治疗(附25例分析)

Diagnosis and Interventional treatment of delayed renal hemorrhage following percutaneous nephrolithotomy(analysis of 25 cases)

目的:探讨经皮肾镜取石(PCNL)术后迟发性肾出血的DSA表现和介入治疗价值。方法:回顾分析25例PC-NL术后迟发性肾出血患者的DSA资料,观察介入治疗后疗效、复发情况及并发症等。结果:DSA显示假性动脉瘤12例,动静脉瘘7例,假性动脉瘤伴动静脉瘘4例,无异常征象2例。25例均一次栓塞成功,栓塞剂为明胶海绵、聚乙烯醇(PVA)颗粒或弹簧圈,随访1～6个月,血尿无复发,无严重并发症发生。结论:DSA能明确PCNL术后迟发性肾出血的原因,超选择肾动脉栓塞能有效止血、保存肾功能,对PCNL术后迟发性肾出血的治疗有重要临床价值。

Objective：To study DSA characteristics and the value of interventional treatment of delayed renal hemorrhage following percutaneous nephrolithotomy（PCNL）.Methods：DSA manifestations in 25 cases were analyzed retrospectively,and then effectiveness of interventional treatment and recurrent hemorrhage and complications were observed.Results：Of 25 cases,12 cases were pseudo-aneurysms,7 cases were arterial-venous fistulas,4 cases were pseudo-aneurysms with arterial-venous shunts.and 2 cases were no abnormal.Successful embolization was performed with PVA or gelfoam or coil in all 25 cases once.There was no recurrence of hematuria in 1～6 months follow up and no serious complications were induced.Conclusion：Super selective renal arterial angiography and embolization is great significance not only in diagnosis but also in treatment of delayed renal hemorrhage due to PNCL.