损伤性肾出血的介入治疗

The interventional treatment for traumatic renal hemorrhage

目的探讨介入超选择性肾动脉造影及栓塞治疗经保守治疗无效的肾损伤出血的临床价值方法2006年5月至2011年12月收治76例肾脏损伤出血患者,采用肾动脉造影.明确肾动脉损伤的部位及程度,采用明胶海绵或弹簧圈对出血动脉行超选择性栓塞治疗。结果 76例患者经超选择插管明胶海绵颗粒或金属弹簧圈栓塞后均能有效止血,栓塞后造影显示出血动脉中断闭塞,肾动脉出血征象消失术后1～3 d肉眼血尿消失。随访未再次发生出1血情况.未见继发性肾功能损害发生。结论对保守治疗无效的肾损伤出血患者,介入性超选择肾动脉栓塞治疗疗效确切,发全有效,能最大限度的降低肾功能损害。

Objective To assess the clinical value of super-selective renal arterial angiography and transcatheter embolization in treating traumatic renal hemorrhage when conservative treatment is unsuccessful. Methods During the period from May 2006 to Dec. 2011, a total of 76 patients with traumatic renal hemorrhage were admitted to authors＇ hospital. Renal angiography was performed to clarify the site and extent of the renal artery injuries. Super-selective embolization with gelfoam particles or steel coils was employed to occlude the bleeding arteries. The results were analyzed. Results After super-selective catheterization and embolization with gelfoam particles or steel coils the bleeding was effectively stopped in all 76 patients. Angiography performed after the treatment showed that the bleeding arteries were interrupted and occluded, and the angiographic b｜eeding signs disappeared. Gross hematuria disappeared within 1- 3 days after the embolization. During the follow-up period no recurrence of bleeding or secondary renal function damage occurred. Conclusion For the traumatic renal hemorrhage that fails to respond to conservative treatment, super-selective renal artery catheterization and embolization is reliable, safe and effective, and this treatment can maximally reduce the renal function damage.（J Intervent Radiol, 2012, 21： 504-506）