经皮肾镜取石术后严重出血的动脉栓塞治疗

Artery Embolization for Severe Hemorrhage after Percutaneous Nephrolithotomy

目的总结超选择性肾动脉栓塞治疗经皮肾镜取石术后严重出血的临床经验。方法回顾分析2009年10月-2012年11月行经皮肾镜取石术后发生严重出血的6例(2.74%)患者的临床资料和对其进行超选择性肾动脉栓塞术的血管造影表现和栓塞疗效。结果患者平均年龄67岁,经皮肾镜取石术后急性出血1例,迟发出血5例,均有体外冲击波碎石史或糖尿病、高血压病史。肾动脉造影显示损伤动脉为肾后下段动脉、肾下段动脉分支,表现为假性动脉瘤5例,动静脉瘘1例。使用弹簧圈或聚乙烯醇颗粒超选择性栓塞,栓塞后出血无一例复发。随访6个月,5例肾功能未见下降,1例受损。结论经皮肾镜术后严重出血与术中动脉损伤有关,采用超选择性肾动脉栓塞术能够达到迅速止血、尽可能保全患肾功能、有效挽救生命的诊疗效果。

Objective To summarize the clinical experience of interventional treatment of super-selective renal artery embolization for severe hemorrhage in patients with post-percutaneous nephrolithotomy（PCNL）.Methods From October 2009 to November 2012,super-selective artery embolization was used to control severe hemorrhage of 6 patients（2.74%）.The clinical data and angiography manifestation of renal angiography and angio-embolization were reviewed.Results The average age of the 6 patients was 67 years old.The history of 6 patients with either extracorporeal shock wave lithotripsy or hypertension or diabetes mellitus was revealed.Vessel injury to renal artery branches of posterior inferior or inferior segment was detected on renal angiography,and totally there were 5 pseudoaneurysms and 1 arteriovenous fistulum respectively.The hemorrhage in all 6 patients ceased completely with spring coil or polyving akohol particles embolization;no patients with recurrence were found.During follow-up period within 6 months post-embolization,renal function was kept well in 5 patients whereas in 1 with renal damage.Conclusions Severe hemorrhage in patients with PCNL is closely associated to operative arterial injury.It can be stanched by super selective arterial embolization.