高温高压处理后的明胶海绵颗粒栓塞医源性肾损伤出血的价值

The Value of the Embolization with the Gelatin Sponge Particles Treated with High Temperature and High Pressure in the Therapy of Iatrogenic Renal Injury Hemorrhage

目的探讨经高温高压处理后的明胶海绵颗粒栓塞医源性肾损伤出血的原理、疗效及安全性。方法回顾性分析11例医源性肾损伤出血患者,用经高温高压处理的明胶海绵颗粒混合液行介入栓塞治疗,观察其安全性、临床疗效。其中,肾切开取石出血4例,经皮肾镜取石出血5例,肾穿刺活检后出血2例。结果本组11例均为段以下动脉出血,其中假性动脉瘤3例,动-静脉瘘3例,造影剂外溢5例。一次栓塞成功10例,术后1~3d肉眼血尿消失,疗效满意,无严重并发症。1例栓塞术3d后再发出血,经第2次栓塞完全止血。术后平均随访10个月,疗效确切,未发现严重并发症,患肾功能得到最大程度保护。结论经高温高压处理后的明胶海绵栓塞治疗医源性肾损伤出血是安全有效的手段,能最大程度保护患肾功能。

Objective To explore the principle,efficacy and safety of the embolization of the gelatin sponge particles treated with high temperature and high pressure in the therapy of iatrogenic renal injury hemorrhage.Methods The data of 11 patients with iatrogenic renal injury hemorrhage who were giver the embolization of the mixed liquid of gelatin sponge particles treated with high temperature and high pressure were analyzed retrospectively to investigate the clinical efficacy and safety.Among the 11 cases,there were 4 cases of hemorrhage caused by nephrolithotomy,5 cases of hemorrhage caused by percutaneous nephrolithotomy and 2 cases of hemorrhage caused by renal needle biopsy.Results All the hemorrhage of 11 cases was below the segmental artery,and there were 3 cases of false aneurysm,3 case of arteriovenous fistula,and 5 case of contrast extravasation.The one-time embolization was successful in 10 cases with the disappearance of macroscopic hematuria after 1 to 3 days of operation,satisfactory efficacy and no serious complications.Only one case had the recurrent hemorrhage after 3 days of operation and the complete hemostasis after the second time of embolization.The average time of follow-ups was 10 months.The curative effect was good with no serious complications and the renal function was protected to the maximum extent.Conclusion The embolization of the gelatin sponge particles treated with high temperature and high pressure is safe and effective in the therapy of iatrogenic renal injury hemorrhage and it can protect the renal function to the greatest extent.