经皮肾镜取石术后迟发性肾出血的介入治疗

Interventional treatment of delayed renal hemorrhage occurred after percutaneous nephrolithotomy

目的 评价超选择性肾动脉栓塞治疗经皮肾镜取石术后迟发性肾出血的价值.方法 收集2007年2月～2013年2月上尿路结石患者行经皮肾镜取石术治疗,术后出现迟发性出血且保守治疗无效患者27例,1例DSA检查无阳性征象,其余26例病例均行超选择性肾段及肾段下动脉栓塞治疗.结果 DSA检查出血原因有单纯性造影剂溢出5例,假性动脉瘤形成16例,动静脉瘘形成2例,假性动脉瘤合并动静脉瘘3例,1例无异常阳性DSA征像.26例病例均一次性栓塞治疗,出血得到有效控制.术后随访3个月～5年,无严重并发症发生.结论 超选择性肾动脉栓塞治疗经皮肾镜取石术后迟发性肾出血安全、疗效确切,能最大限度保护肾脏功能,可作为临床治疗首选方法.

Objective To evaluate the value of super-selective renal arterial embolization in treating delayed renal hemorrhage occurred after percutaneous nephrolithotomy.Methods 27 patients with delayed renal hemorrhage occurred after percutaneous nephrolithotomy were treated with super-selective renal arterial embolization except 1patient.Results Successful embolization with single session was achieved in all 27 cases except 1case with no lesion detected.Of another26 cases,5showed simple contrast medium extravasation,16pseudo-aneurysm,2arterial-venous fistulas,3 pseudoaneurysms accompanied with arterial-venous shunts.The findings of hemorrhage disappeared after the embolization treatment.Concluusion Super-selective renal arterial embolization is safe and effective,and this treatment can maximally reduce the renal dysfunction.