介入栓塞治疗儿童肾活检术后假性动脉瘤一例并文献复习

Interventional treatment of post-biopsy renal artery pseudoaneurysm in a child： case report and literature review

目的 探讨儿童肾活检术后假性动脉瘤形成的临床特点和介入栓塞治疗的应用.方法 报告2006年5月山东省立医院儿科肾活检术后假性动脉瘤形成1例,并复习国内外相关文献,分析假性动脉瘤的诊断及治疗方法.结果 13岁男孩,肾活检术后第10天出现持续肉眼血尿、腰痛及进行性加重的排尿困难;入院时血红蛋白110 g/L,入院后第4天92 g/L,第7天83 g/L,第8天74 g/L;B超见右肾盂、膀胱内实性团状回声,肾脏彩色多普勒超声显示右肾下极囊性结构内红蓝相对的旋转的血流信号,对比增强CT示右肾下极皮髓质交界区一直径约0.5 cm的异常强化点,右肾盂肾盏输尿管及膀胱内大小不等充盈缺损.经止血、补充红细胞、扩容等治疗7d,肉眼血尿持续加剧.肾活检术后第19天肾动脉血管造影确诊假性动脉瘤.行明胶海绵颗粒及微弹簧圈成功栓塞出血部位,介入治疗后患儿肉眼血尿消失.以“假性动脉瘤,儿童”为关键词,在PubMed、中国知网、万方数据库检索国内外相关文献,获取临床资料完整的中英文报道儿童肾活检术后假性动脉瘤4例,其中3例基础疾病为紫癜性肾炎,1例为Sneedon综合征.有肉眼血尿4例,腰痛/穿刺部位疼痛2例,发热2例,排尿痛1例.均经介入栓塞止血成功.结论 儿童肾活检术后假性动脉瘤常有肉眼血尿、腰痛或穿刺部位疼痛、发热、排尿痛甚至排尿困难,肾动脉造影确诊,血管内介入栓塞治疗有效.

Objective To investigate the characteristics,diagnosis and therapy of post-biopsy renal artery pseudoaneurysm in children and to study the clinical value of arterial embolization for traumatic renal hemorrhage when conservative treatment failed.Method Data were compiled from medical records of a child in whom renal artery pseudoaneurysm occurred after biopsy in the Provincial Hospital Affiliated to Shandong University,and the related literature was reviewed to analyze the diagnosis and treatment of such pseudoaneurysm.Result A 13-year-old boy had gross hematuria,aggravated dysuria and decreased hemoglobin 10 days after percutaneous renal biopsy.Hb decreased from 110 g/L on the first day after admission to 92 g/L on the 4th day,83 g/L on the 7th day and the minimum to 74 g/L at the 8th day after admission.Ultrasound showed solid echogenic mass in the right renal pelvis as well as the bladder.Color Doppler ultrasound shows the red and blue rotation of blood flow in the polar capsule under the right kidney.Contrast-enhanced CT in the arterial phase showed a 0.5 cm sized renal mass with a strongly enhanced dot in the lower pole of the right kidney,suggesting a renal artery pseudoaneurysm.Haemostatic,supplement of red blood cells and blood volume and other integrative treatment of hematuria were applied for seven days,but his gross hematuria continued to be worsened.He was diagnosed as pseudoaneurysm by digital subtraction angiography （DSA） on the 19th day after renal biopsy.Superselective renal artery embolization using micro-coils and gelatin sponge particles was performed,and the blood clots were cleaned under cystoscope.Macro-haematuria and dysuria disappeared after the interventional treatment.Retrieval of reports on post-biopsy renal artery pseudoaneurysm in children by using ＂ pseudoaneurysm,child＂ as the search term showed report of one case from the Chinese CNKI database and 3 cases from the PubMed database.The underlying disease was Henoch-Schonlein purpura nephritis in 3 cases and Sneedon syndrome in 1 case;clinical manifestation of gross haematuria was present in 4 cases,lumbago or pain at the site of the puncture in 2 cases,dysuria in 1 case,and fever in 2 cases.Conclusion The post-biopsy renal artery pseudoaneurysm in children is often manifested as gross hematuria,lumbago,pain at the site of the puncture,fever and dysuria,DSA can be used for definite diagnosis and the interventional treatment is effective.