经导管介入栓塞治疗顽固性血尿的临床效果观察

Clinical efficacy of transcatheter arterial embolization in the treatment of intractable hematuria

目的：探讨介入栓塞治疗经皮肾镜取石术（ PCNL）后顽固性血尿的临床疗效。方法回顾性分析我院2014年2月至2016年3月行PCNL后出现顽固性血尿36例患者的临床资料。所有患者均经过保守治疗无效，于我院行肾动脉造影明确病变，行Embosphere微球或聚乙烯醇颗粒联合弹簧圈介入栓塞治疗。术后观察尿色变化情况、术后并发症及随访观察有无再次出血。结果（1）成功率：36例患者均一次成功栓塞成功，术后1～3 d血尿症状逐渐消失，止血有效率达到100％。（2）并发症：术后10例患者出现不同程度的栓塞后综合征，给予止痛、止吐等治疗后症状逐渐缓解。1例患者术后出现一过性肌酐升高，经对症治疗7 d后肾功能恢复正常。（3）随访：术后随访3～6月均无再次出血。结论经导管介入栓塞治疗顽固性血尿，疗效确切，创伤小，安全性高，并发症少，术后恢复快。

Objective To investigate the clinical effect of interventional embolization in the treatment of intractable hematuria after percutaneous nephrolithotripsy. Methods A retrospective analysis of the First Affili-ated Hospital of Kunming Medical University from February 2014 to March 2016 after percutaneous nephrolithot-omy appears intractable hematuria patients in 36 cases was conducted. All patients were treated with conservative treatment but invalid,then lesion was confirmed by renal artery angiography,after that,line embosphere micro-spheres or polyvinyl alcohol particles combined with spring ring interventional the treatment was conduc-ted. Postoperative urine color changes, postoperative complications and follow-up were observed whether have bleeding again. Results （ 1） The success rate：36 cases patients all with successful embolization,the symptoms of hematuria in 1-3 days gradually disappeared,and the effective rate was 100%. （ 2） Complications：the compli-cations after operation in 10 patients appeared different degree of embolism syndrome,given analgesic and antie-metic,the symptoms gradually ease after treatment. One case patient with a transient increase of creatinine after operation,renal function returned to normal 7 days after the treatment. （ 3） Follow up：there was no recurrence of hemorrhage after 3-6 months of follow-up. Conclusion Transcatheter embolization in the treatment of intracta-ble hematuria has definite curative effect,less trauma,high safety,less complications and faster postoperative re-covery.