复杂性PCNL术后肾出血介入治疗认识及临床应用

Clinical use of interventional treatment in compex renal hemorrhage after percutaneous nephrolithotomy

目的提高对PCNL术后复杂性肾损伤出血的认识。方法选取2003年3月至2018年3月在本院手术发生严重肾出血和由外院手术转来进行肾动脉栓塞止血患者685例,其中复杂性肾损伤出血患者61例,均使用明胶海绵粒(条)、PVA、丝线或弹簧圈进行栓塞;超选择性肾动脉栓塞止血50例,全肾动脉栓塞止血11例。结果 DSA显示多支或多处肾动脉损伤出血23例,肾动、静脉损伤出血(肾A-V瘘)11例,肾动脉损伤出血+肾A-V瘘16例,肾静脉损伤出血6例,弥漫性肾动、静脉损伤出血5例,一次性肾动脉栓塞止血痊愈出院58例,2例进行了2次以上栓塞止血。结论对PCNL术后复杂性肾血管损伤出血进行个体化肾动脉栓塞治疗能达到微创止血目的。

Objective To improve severe renal hemorrhage after percutaneous nephrolithotomy(PCNL). Methods We retrospectively analyze the data of 685 patients with severe renal hemorrhage after percutaneous nephrolithotomy, including 61 compex injuried renal hemorrhage cases,which received renal artery embolization using gelatin sponge PVA threads or steel coils, from March 2003 to March 2018, which superselectived renal artery embolization 50 cases, totel renal artery embolization 11 cases. Results Digital subtraction angiography(DSA) results showed 23 cases more injuried renal aterial branches or moe injuried places, 11 cases injuried renal aterial and vein(arteriovenous fistula, AVF), 16 cases injuried renal aterial + renal AVF, 6 cases injuried renal vein, 5 cases injuried widely renal aterial and vein, one-time renal artery embolization hemostasis was cured and discharged in 58 cases, 2 cases were embolized more than twice to stop bleeding. Conclusion Individual renal arteriolar embolizaion can promptly stop the complex injuried renal hemorrhage after PCNL.