超选择肾动脉弹簧圈栓塞术治疗经皮肾镜碎石取石术后严重出血的疗效

Effect of superselective renal artery coiling embolization on severe bleeding after percutaneous nephrolithotripsy

目的超选择肾动脉弹簧圈栓塞术治疗经皮肾镜碎石取石术(PCNL)后严重出血的疗效。方法收集2017年1月至2020年12月河北燕达医院收治的PCNL后严重出血行超选择肾动脉弹簧圈栓塞术治疗39例患者临床资料。统计PCNL后患者肾动脉出血情况;术后不良反应(恶心、呕吐、发热、腰痛);栓塞术成功率和术后肾功能情况。结果肾动脉上支出血率17.95%、中支出血率51.28%、下支出血率30.77%;迟发性出血率53.85%、持续性出血率46.15%;输血率58.97%。39例患者的栓塞成功率94.87%;术后不良反应中,恶心发生率17.95%,呕吐发生率12.82%,发热发生率25.64%,腰疼发生率43.59%。术后的肾小球滤过率高于术前,血清尿素氮和血清肌酐低于术前,差异有统计学意义(P<0.05)。结论PCNL术后严重出血患者应尽快行数字减影血管造影(DSA)明确诊断后进行栓塞治疗,DSA和超选择肾动脉弹簧圈栓塞术可作为PCNL大出血首选的检查及治疗方法,超选择肾动脉弹簧圈栓塞术是安全有效的治疗方式,值得推广。

Objective To study the efficacy of superselective renal artery coil embolization in the treatment of percutaneous nephrolithotomy(PCNL)with massive hemorrhage.Method The clinical data of 39 patients with severe bleeding after PCNL treated by superselective renal artery coil embolization in Hebei Yanda Hospital from January 2017 to December 2020 were collected.Statistics of renal artery bleeding after PCNL;postoperative adverse reactions(nausea,vomiting,fever,low back pain);the success rate of embolization and postoperative renal function.Result The upper branch of renal artery bleeding was 17.95%,the middle branch bleeding was 51.28%,and the lower branch bleeding was 30.77%.Delayed hemorrhage 53.85%,persistent hemorrhage 46.15%.The blood transfusion rate was 58.97%.The success rate of embolization was 94.87%.Among the postoperative adverse reactions,the incidence of nausea was 17.95%,the incidence of vomiting was 12.82%,the incidence of fever was 25.64%,and the incidence of low back pain was 43.59%.The glomerular filtration rate after operation was higher than that before operation,and the serum urea nitrogen and serum creatinine were lower than those before operation(P<0.05).Conclusion Patients with severe hemorrhage after PCNL should be treated with digital subtraction angiography(DSA)as soon as possible.DSA and superselective renal artery coil embolization can be used as the first choice for the examination and treatment of PCNL massive hemorrhage.Superselective renal artery coil embolization is a safe and effective treatment,which is worth popularizing.