经皮肾镜取石术后严重出血行选择性肾动脉栓塞11例临床分析

Clinical analysis of 11 cases undergoing selective renal artery embolization for severe post-percutaneous nephrolithotomy hemorrhage

目的：总结选择性肾动脉栓塞术（SRAE）治疗经皮肾镜取石术（PCNL）术后严重出血的临床经验。方法：回顾性分析我院于2007年2月-2014年2月行PCNL发生术后严重出血的11例患者的临床资料和对其行SRAE的血管造影表现和疗效。结果：PCNL术后严重出血需行SRAE治疗的患者止血效果均满意,手术成功率100%;SRAE后1-3d患者肉眼血尿完全消失,血红蛋白指标上升,全身症状改善。1例SRAE后第3天出现发热、患侧腰痛症状,予对症治疗后不适消退。本组患者SRAE治疗后5d出院,随访1-6个月,术后恢复良好。结论：PCNL术后严重出血与术中动脉损伤有关,在临床操作中具有不可预见性,应严格规范PCNL的操作以减少术后严重出血的发生。术后出血严重者早期行SRAE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 selective renal artery embolization（SRAE）for severe post-percutaneous nephrolithotomy hemorrhage.Method：From February 2007 to February 2014,SRAE was used to control severe hemorrhage of 11 patients after percutaneous nephrolithotomy（PCNL）in our hospital.The clinical data,renal artery angiography manifestation and the result of angio-embolization were retrospectively analysed.Result：All of the 11 cases with severe hemorrhage after PCNL were managed satisfactorily by SRAE.Achievement ratio of SRAE was 100%.Macroscopic haematuria disappeared 1-3days after embolization.Hemoglobin increased and systemic symptom improved.Symptoms of fever and lumbago were found in one case three days after embolization,and the discomfort subsided by symptomatic treatment.All patients were discharged five days after embolization.During follow-up period of 1-6months after embolization,all patients recovered well.Conclusion：Severe hemorrhage in patients after PCNL is closely associated with artery injury during operation.Strictly qualified operation should be performed to reduce the occurrence of severe hemorrhage for it is unpredictable clinically.Rapid and effective hemostasis,preservation of renal function and saving lives can be acquired by early SRAE.