超选择肾动脉多材料栓塞治疗PCNL术后肾出血的临床应用

Clinical Application of Super-Selective Renal Artery Embolization by Multi-Material for Treatment of Renal Hemorrhage following PCNL

目的探讨经皮肾镜取石(PCNL)术后肾出血的血管造影诊断和采用多种材料进行肾动脉栓塞治疗的临床应用价值。方法搜集2011年2月至2015年3月PCNL术后肾出血患者共27例,均予肾动脉造影,根据造影情况分别行超选择多材料栓塞治疗[栓塞材料采用明胶海绵、聚乙烯醇(PVA)、弹簧圈及无水乙醇]。术后总结造影表现及进行患者随访,观察其疗效及安全性。结果 27例患者中26例血管造影呈阳性改变,其中动静脉瘘12例、假性动脉瘤11例。26例造影结果阳性者均成功进行栓塞治疗(其中2例进行了第2次栓塞),另1例造影阴性者予以术中灌注止血药,术后所有患者均出血停止,随访6个月未见有复发出血及严重并发症发生。结论血管造影能明确PCNL术后肾出血原因,超选择肾动脉多材料栓塞具有安全、高效、并发症少等优点,其止血效果显著,对PCNL术后肾出血治疗有重要临床价值。

Objective To investigate the clinical value of angiography diagnosis and super-selective arterial embolization by multi-material in the treatment of renal hemorrhage after percutaneous nephrolithotomy（ PCNL）. Methods A total of 27 patients with persistent or intermittent gross hematuria that occurred after PCNL,who were encountered at authors＇ hospital during the period from February 2011 to March 2015,all patients received renal arteriography and super-selective arterial embolization by multi-material according to the results（ embolization with PVA、Gelfoam particles、steel coils and ethanol）. To summarize the imagings and follow-up for 6 months,the effectiveness and safety of treatment were observed. Results 26 patients have a positive result with the renal arteriography,arteriovenous fistulas in 12 cases,pseudo-aneurysms in11 cases,then a successful embolization with these patients（ 2 cases have the second embolization）. The patient with negative imaging have a transcatheter arterial perfusion of hemostatic. The active bleeding stopped after treatment,follow-up for6 months,no recurrence of hematuria or severe complications occurred. Conclusion Super-selective renal arteriography and embolization by multi-material has great significance,not only in diagnosis but also in treatment of renal hemorrhage due to PNCL.