经皮肾镜取石术后肉眼血尿与肾动脉造影表现的相关性分析及介入治疗时机

Timing of Interventional Therapy and Correlation Analysis Between Gross Hematuria After Percutaneous Nephrolithotomy and Manifestations of Renal Arteriography

目的探讨经皮肾镜取石术(PCNL)后肉眼血尿的临床分型与肾动脉造影表现的相关性和超选择性肾动脉栓塞的治疗时机。方法回顾性分析78例PCNL后肉眼血尿患者的临床表现和造影征象,其中76例行超选择性肾动脉栓塞治疗。结果根据肾出血的临床表现分为Ⅲ型:急性持续性出血(Ⅰ型)17例,间歇性活动性出血(Ⅱ型)50例,缓慢持续性出血(Ⅲ型)11例。肾动脉造影表现:假性动脉瘤37例,假性动脉瘤并动静脉瘘14例,动静脉瘘10例,对比剂外溢8例,对比剂外溢并动静脉瘘4例,假性动脉瘤并肾盏瘘2例,首次造影阴性3例。成功栓塞76例,4例栓塞后再出血行第2次栓塞。2例造影阴性者经导管注入血凝酶1IU后保守治疗出血停止。结论超选择性肾动脉栓塞是PCNL后出血的最好治疗方法,对于Ⅰ、Ⅱ型出血,应尽快行超选择性肾动脉栓塞治疗,而对于Ⅲ型出血,若保守治疗出血控制不理想时,也应该行肾动脉栓塞治疗。

Objective Explore correlation of macroscopic hematuria clinical typing after percutaneous nephrolithotomy（ PCNL） and representation of renal arteriography and treatment timing of superselective renal artery embolization. Methods A retrospective analysis of clinical and angiographic manifestations among 78 patients with hematuria after PCNL,including 76 cases of super-selective renal artery embolismic treatment were done. Results According to the clinical manifestations,the traumatic renal hemorrhage were classified into 3 types： acute hemorrhages（ type Ⅰ） in 17 cases,intermittent active bleeding（ type Ⅱ） in 50 cases,slow continuous bleeding（ Ⅲ） 11. Renal Arteriography： pseudoaneurysm in37 cases,14 cases of pseudoaneurysm and arteriovenous fistula and arteriovenous fistula in 10 cases,contrast extravasation in 8 cases,contrast extravasation and arteriovenous fistula in 4 cases,2 cases of False aneurysm and renal calyceal fistula,contrast negative 3. Successfully in 76 cases,4 cases of recurrent hemorrhage after intravenous Thrombolysis 2nd embolism. 2 cases of Imaging after injection of hemocoagulase 1IU,the negative conservative treatment for the bleeding stoped.Conclusion superselective renal artery embolization is the best treatment for bleeding after PCNL,for Ⅰ,Ⅱ-bleeding,consult your superselective renal artery embolization for the treatment,and Ⅲ-bleeding,when conservative treatment for bleeding control is not satisfactory,should also be treated with embolization of renal artery.