出血性肾疾病的诊断策略与介入治疗价值

Diagnosis strategies of the renal hemorrhage and the treatment value of interventional embolization

目的:探讨出血性肾疾病的诊断策略与介入栓塞止血的治疗价值。方法:15例肾出血患者均行肾动脉数字减影血管造影(DSA)检查,采用微弹簧圈、明胶海绵颗粒及PVA微粒栓塞出血点,比较分析手术前后观察指标的变化。结果:15例肾脏出血患者经超选择性肾动脉造影均获得了明确的诊断,均可见不同程度的对比剂外溢。2例采用明胶海绵颗粒、PVA颗粒栓塞,13例采用微弹簧圈一次栓塞成功。总有效率为93.3%(14/15),肉眼血尿术后平均3 d消失,1例栓塞后再发多处出血。术后动态复查血尿素氮、肌酐及血压均正常,平均随访18个月无肾出血复发。结论:DSA是检查肾出血原因的可靠方法,选择性肾动脉栓塞治疗肾出血为首选治疗方法。选择适当的栓塞材料,可以降低复发率及异位栓塞发生率。

0bjective To explore the diagnosis strategies of the renal hemorrhage and the treatment value of interventional embolization. Methods 15 cases of renal hemorrhage patients underwent renal artery digital subtraction angiography （DSA）, and the bleeding points were embolismed by use of micro-coils, gelatin sponge particles or PVA particles, and analyzed the changes of the index before and after operation. Results 15 cases of patients with renal hemorrhage were diagnosed by the （super） selective renal arteriography, and varying degrees extravasation of contrast medium was seen. Two cases were embolized using gelatin sponge particles and PVA particles, 13 cases with micro-coils underwent the first-time successful embolization. The total effective rate was 93.3% （14/15）, Gross hematuria was disappeared in an average of three days after operation, one cases of multiple bleeding was recurred after operation. A dynamic review with blood urea nitrogen, blood creatinine, and blood pressure were normal. No recurrent hemorrhage was found in an average follow-up 18 months. Conclusion：DSA is a reliable method to check the cause of renal hemorrhage. Selective renal arterial embolization is the preferred management for renal hemorrhage. Select the appropriate embolic material can reduce the relapse rate and the incidence of ectopic embolization.