医源性肾出血的超选择性肾动脉栓塞治疗

Superselective renal artery embolization for the treatment of iatrogenic renal hemorrhage

目的探讨超选择肾动脉栓塞术治疗医源性肾岀血的临床应用价值,方法2003年9月-2011年2月收治17例严重血尿的医源性肾出血患者,行选择性肾动脉数字减影血管造影(DSA),采用超选择插管后用明胶海绵和弹簧圈栓塞治疗,并平均随访6个月以上。结果16例DSA清晰显示患者病侧肾对比剂外溢,均1次栓塞成功,另1例2次栓塞成功,出血均停止。17例全都保留患肾功能和大部分组织,无严重并发症,随访期间所有患各均无血尿复发。结论超选择肾动脉栓塞治疗医源性肾出血成功率高、见效快、创伤小、并发症少,能最大限度地保护正常肾组织,可作为首选治疗方法,具有较高的临床应用价值。

Objective To investigate the clinical application of superselective renal artery embolization in the treatment of iatrogenic renal hemorrhage. Methods A total of 17 patients with severe hematuria due to iatrogenic renal hemorrhage, who were encountered in authors＂ hospital during the period from Sep. 2003 to Feb. 2011, were enrolled in this study. Selective renal arterial digital subtraction angiography （DSA） was performed in all patients, which was followed by superselective renal artery embolization with gelatin sponge and coils. All patients were followed up for a mean period of 6 months. Results DSA demonstrated contrast extravasation within the diseased kidney in 16 patients, and embolization was successfully accomplished with a single processing. The remaining one patient received two times of embolization procedure. The blood urine ceased in all patients. The most part of the renal tissue and the renal function was reserved in all 17 patients. No severe complications occurred. No recurrence of hematuria was observed during the following-up period. Conclusion For the treatment of iatrogenic renal hemorrhage, superselective renal artery embolization is instantly effective and minimally invasive with higher success rate and fewer complications. Besides, it can protect the normal renal tissue to the greatest possible advantage. Therefore, this technique should be regarded as the treatment of first choice.