选择性肾动脉栓塞治疗经皮肾镜取石术后肾出血的临床应用分析

Clinical application of selective renal artery embolization to control postoperative hemorrhage after percutanous nephrolithotomy (PCNL)

目的探讨经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)后严重肾出血经选择性肾动脉栓塞治疗的方法及临床价值。方法对2009年1月至2018年1月在西南医院采用介入治疗的65例PCNL术后严重肾出血患者的临床资料、DSA造影检查结果、栓塞治疗方式、治疗效果进行回顾性分析。结果65例肾出血患者中,造影表现为假性动脉瘤21例(32.3%),动静脉瘘10例(15.4%),造影剂外溢24例(36.9%),假性动脉瘤合并动静脉瘘2例,1例表现为局部血管走形僵硬、连续性中断,1例表现为血管远端显影缓慢,6例为阴性表现。59例为造影显示出血的阳性病例,均成功栓塞,3例复发出血,行第二次栓塞治疗后出血停止。2例死亡,均为PCNL术后大出血并失血性休克,栓塞后患者持续病情加重,多器官功能衰竭而死亡。6例造影检查阴性,1例根据穿刺造瘘部位行选择性栓塞治疗,其余5例未栓塞,保守治疗后出血停止。结论经导管选择性肾动脉栓塞术具有止血效果确切、创伤小的优点,可以作为PCNL术后严重肾出血的首选治疗手段。

Objective To explore selective renal artery embolization treatment postoperative hemorrhage after percutanous nephrolithotomy(PCNL)methods and its clinical value.Methods From January 2009 to January 2018,there were 65 cases of acute renal hemorrhaging in the hospital in Southwest Hospital,and the results of the DSA,the treatment,the therapeutic effects were retrospectively analyzed.Results In 65 case of renal hemorrhage,angiography represented 21 case of pseudoaneurysm(32.3%),arteriovenous fistula in 10 cases(15.4%),Contrast extravasation in 24 cases(36.9%),2 cases of pseudoaneurysm complicated with arteriovenous fistula,1 case presented local vascular malformation stiffness and continuity disruption.1 case showed slow development of distal vessels,6 cases presented negative findings.59 patients who angiographic finding bleeding underwent successful embolization.A second embolization procedure was required in 3 patients for uncontrolled bleeding.2 cases died,all are PCNL postoperative bleeding and uncontrolled hemorrhagic shock,embolism patients after last illness aggravating,multiple organ failure and death.Six of the cases were negative,and one received selective embolization according to the site of puncture and fistula,while the other 5 patients were not embolized,and the bleeding stopped after conservative treatment.Conclusion Percutaneous selective renal arterial embolization has the advantages of accurate hemostasis and small trauma,and can be the preferred treatment for severe renal hemorrhage after PCNL.