超选择性肾动脉栓塞术治疗经皮肾镜取石术后迟发性大出血

Characteristics and Management of Massive Hemorrhage Secondary to Percutaneous Nephrolithotomy

目的分析经皮肾镜取石术（PCNL）后迟发性大出血的原因、特征,并评价超选择性肾动脉栓塞术对其的治疗价值。方法回顾性分析2005年4月-2013年6月28例接受PCNL后大出血患者接受超选择性肾动脉栓塞术的临床资料。结果 28例患者出血多表现为间歇性反复发作,内科保守治疗无效后,接受超选择性肾动脉造影加栓塞治疗,出血均得到有效控制。随访6~62个月,平均41.6个月,无血尿及其他并发症。结论选择性肾动脉栓塞术是治疗PCNL术后迟发性大出血安全、有效的手段,可作为保守治疗无效患者的首选治疗方法。

Objective To analyze the causes and characteristics of massive hemorrhage secondary to percutaneous nephrolithotomy （PCNL） and assess the value of superselective renal artery embolization in the management of this condition. Methods The imaging data and prognosis of 28 patients who developed repeated massive hemorrhage secondary to PCNL and underwent superselective renal artery embolization between April 2005 and June 2013 were reviewed. Results Following superselective renal artery embolization, hemorrhage was effectively controlled in all the 28 patients. Follow-up lasted from 6 to 62 months, averaging 41.6 months. No hematuria or other complications occurred during the follow-up period. Conclusion Superselective renal artery embolization is safe and effective in managing massive hemorrhage secondary to PCNL, and it may be used as a preferred treatment for patients who are refractory to expectant treatments.