经皮肾镜取石术后肾动脉损伤造影表现及栓塞治疗

Angiographic manifestations and embolization treatment of renal artery injury caused by percutaneous nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)后肾动脉损伤肾动脉造影表现及超选择性肾动脉栓塞术(SRAE)治疗效果。方法收集2010年1月至2014年6月PCNL术后出现持续性或间歇性肉眼血尿患者共22例,均经肾动脉造影证实为肾动脉损伤,并接受SRAE术治疗,栓塞材料为微弹簧圈。术后随访3个月。结果 22例患者中DSA造影表现为肾动脉假性动脉瘤(RAP)14例(63.6%),肾动静脉瘘(RAVF)5例(22.7%),RAP伴发RAVF 3例(13.6%)。SRAE术后肾动脉造影显示病变均达到完全栓塞,所有患者活动性出血停止,技术成功率及有效止血率均为100%。术后随访3个月,22例患者均未见血尿复发及严重并发症。20例患者术后出现不同程度的栓塞综合征。结论 RAP、RAVF是PCNL术后肾动脉损伤的主要类型,采用微弹簧圈行SRAE可作为经保守治疗无效患者的首选治疗方法 。

Objective To investigate the angiographic manifestations of renal artery injury caused by percutaneous nephrolithotomy, and to evaluate the therapeutic effect of super-selective renal arterial embolization in treating renal artery injury. Methods A total of 22 patients with persistent or intermittent gross hematuria that occurred after percutaneous nephrolithotomy, who were encountered at authors’ hospital during the period from Jan. 2010 to June 2014, were included in this study. The diagnosis was confirmed by renal angiography in all patients, and super-selective renal arterial embolization with steel micro-coils was carried out in all patients. The patients were followed up for three months. The results were analyzed. Results Of the 22 patients, DSA examination showed that renal artery pseudoaneurysm （RAP） was found in 14 （63.6%）, renal arteriovenous fistula （RAVF） in 5 （22.7%） and RAP associated with RAVF in 3 （13.6%）. Renal angiography performed after super-selective renal arterial embolization showed that complete obstruction of the bleeding arteries was achieved in all patients, and the active bleeding stopped. Both the technical success rate and the hemostasis rate were 100%. During the follow-up period lasting for three months, no recurrence of hematuria or severe complications occurred. In 20 patients, different degree of embolism syndrome was observed after the treatment. Conclusion Renal artery pseudoaneurysm and renal arteriovenous fistula are the main types of renal artery injury after percutaneous nephrolithotomy. Super-selective renal arterial embolization with micro-coils can be used as the treatment of choice for patients who has failed to respond to conservative therapy.