急性肾出血25例动脉造影所见及栓塞治疗

Acute renal hemorrhage: its angiographic manifestations and arterial embolization therapy

目的探讨急性肾出血动脉造影的不同表现及其栓塞治疗的方法与疗效。方法 2009年1月—2011年12月对25例保守治疗无效的急性肾出血患者行选择性动脉造影,根据肾出血动脉造影的不同表现,以明胶海绵、PVA颗粒和弹簧圈等栓塞剂行栓塞治疗。结果 20例患者动脉造影可见对比剂外溢,其中2例合并假性动脉瘤,2例合并肾动静脉瘘,1例合并肾动脉-肾盏瘘,1例为假性动脉瘤破裂合并肾动静脉瘘;另5例显示为肿瘤血管。25例患者采用不同栓塞剂栓塞后出血完全停止,随诊4～10个月,均无再次出血及严重并发症发生。结论急性肾出血动脉造影的各不相同,仔细甄别并选用不同栓塞剂治疗取得了满意的临床疗效。超选择性动脉栓塞治疗急性肾出血能有效止血、最大限度地保存肾功能,可作为肾出血的安全、有效、微创的治疗方法。

Objective To discuss the different angiographic manifestations of acute renal hemorrhage and the appropriate embolization measures. Methods During the period from January 2009 to December 2011, a total of 25 patients with acute renal hemorrhage who had failed to respond to the conservative treatment were admitted to authors＇ hospital. Referring to the angiographic manifestations, super- selective arterial embolization by using appropriate embolic agents, such as gelatin sponge, polyvinyl alcohol particles or steel coils, was carried out in all patients. The patients were followed up for 4 - 10 months, and the results were analyzed. Results The renal angiography showed that contrast extravasation was seen in 20 cases. Of the 20 patients, coexisting pseudoaneurysm was found in 2, accompanied arteriovenous fistula in 2, artery-calyces fistula in one and ruptured pseudoaneurysm together with arteriovenous fistula in one. Tumor vasculatures were revealed in 5 patients. Based on the angiographic findings different embolic agents were employed in different patients. During the follow-up period no recurrent bleeding or severe complications occurred in all patients. Conclusion Acute renal hemorrhage has different angiographic signs. Through carefully observing the angiographic manifestations and strictly selecting appropriate embolic agents, satisfactory clinical effectivenesscan be achieved with embolization therapy. Superselective renal artery embolization can effectively stop the bleeding and preserve the renal function to the greatest possible advantage. Therefore, as a safe, effective and micro- invasive treatment for acute renal hemorrhage this technique should berecommended in clinical practice.（J Intervent Radiol, 2013, 22： 421-424）