超选择性肾动脉栓塞在经皮肾镜取石术后出血的应用时机研究

The timing of super-selective renal artery embolization for the treatment of renal hemorrhage after PCNL

目的探讨经皮肾镜取石术(PCNL)后肾脏出血行超选择性肾动脉栓塞(SRAE)治疗的时机选择。方法 2005年6月至2013年2月,对2 165例上尿路结石患者的2 384个肾脏行PCNL治疗,术后有16例(0.74%)出现严重出血而行SRAE治疗。本文对这16例患者的出血特点及行SRAE的时机进行回顾性分析。结果 16例患者中,行1次SRAE止血成功15例,但在SRAE前或后行单纯性肾动脉造影(RAA)各1例;行2次SRAE止血成功1例。所有患者行初次RAA/SRAE时血色素平均下降32.9g/L,平均输血250mL;再次行RAA/SRAE时血色素时平均下降3.2g/L,未输血。15例患者顺利康复出院,1例死亡。结论对PCNL术后严重出血患者应尽早行SRAE,而对初次RAA阴性或SRAE后再出血的患者则应酌情行SRAE。

Objective To investigate the timing of super-selective renal artery embolization （SRAE） for the treatment of renal hemorrhage after percutaneous nephrolithotomy （PCNL） .Methods From June 2005 to February 2013 ,a total of 2 165 patients with upper urinary tract calculi underwent PCNL （2 384 PCNL procedures） and 16 of them suffered severe bleeding （0 .74% ） .In the 16 cases ,SRAE was used .The medical records of all the 16 cases were retrospectively analyzed .Results In 16 patients ,15 patients were successful with the first SRAE ,but 2 of them underwent an additional pure renal artery angiography （1 patient before SRAE and 1 patient after SRAE）;1 healed after the second SRAE .The mean blood loss and transfusion volume were 32 .9 g/L and 250 mL before the first angiography/SRAE ,and an additional 3 .2 g/L and 0 mL before the second try .Although 1 patient died ,the oth-ers were recovered without complications .Conclusion SRAE should be adopted early for the treatment of severe renal hemorrhage after PCNL .However ,a second try should be considered for the repeated bleeding patients after the negative results of first renal artery angiography or SRAE .