经导管肾动脉栓塞术治疗常染色体显性遗传性多囊肾病并发血尿的效果和安全性

Transcatheter renal artery embolization for autosomal dominant polycystic kidney disease associated with hematuria: analysis of its efficacy and safety in 12 patents

目的 探讨经导管肾动脉栓塞术(TRAE)治疗常染色体显性遗传性多囊肾病(ADPKD)并发血尿的效果和安全性。方法 回顾性分析2010年1月至2018年12月三明市第一医院采用TRAE治疗的12例ADPKD并发血尿患者临床资料。采用粒径300~900μm三丙烯明胶微粒球(Embosphere)行TRAE术,栓塞靶血管为肾动脉2级以下分支,栓塞终点为靶血管主干对比剂滞留。术中复查造影明确靶血管闭塞情况。观察住院期并发症发生情况,随访30 d内再出血率、肾脏总体积缩小率、血红蛋白升高率。结果 12例患者均成功实施TRAE术,技术成功率100%。术后3 d内11例患者血尿逐渐转清至消失,30 d内无再发血尿,1例90 d后再发血尿,经再次TRAE后血尿消失,止血成功率为91.66%。所有患者腹痛、腹胀较术前缓解,10例出现不同程度腰背部酸痛、低热,经止痛、退热、对症治疗3~5 d后症状消失,无异位栓塞、血管损伤等严重并发症发生。术后30 d内肾脏总体积与术前相比缩小30.47%(P<0.01),血红蛋白水平与术前相比上升22.81%(P<0.01)。结论 TRAE术治疗ADPKD并发血尿安全有效,远期疗效有待更多病例证实。

Objective To investigate the clinical efficacy and safety of transcatheter renal artery embolization(TRAE) for autosomal dominant hereditary polycystic kidney disease(ADPKD) associated with hematuria. Methods The clinical data of a total of 12 patients with ADPKD complicated by hematuria, who received TRAE at the Sanming Municipal First Hospital of China between January 2010 and December 2018,were retrospectively analyzed. TRAE was performed by using 300-900 μm Embosphere microspheres, the target vessels of embolization were the branches below grade 2 of the renal artery. The endpoint of embolization procedure was the contrast retention in the main trunk of the target vessel. Intraoperative angiography was employed to check the target vascular occlusion status. The complications during hospitalization, the incidence of re-bleeding within 30 days after TRAE, the total volume reduction rate of kidneys, and the rate of hemoglobin elevation were recorded. Results Successful TRAE was accomplished in all the 12 patients, with a technical success rate of 100%. In 11 patients, the urine gradually turned clear until hematuria disappeared within 3 days after TRAE, and no hematuria recurred within 30 days. In one patient,hematuria recurred 90 days after TRAE, which disappeared after receiving TRAE again. The hemostatic success rate of hematuria was 91.66%(11/12). Abdominal pain and distention were relieved in all patients,10 patients(83.33%) developed varying degrees of low back pain and mild fever, the symptoms disappeared after symptomatic treatment for 3-5 days. No serious complications such as ectopic embolization, injury of blood vessels, etc. occurred. Thirty days after TRAE, the total kidney volume reduced by 30.47% when compared with preoperative one(P<0.001), while the hemoglobin level increased by 22.81% when compared with preoperative value(P<0.001). Conclusion For the treatment of ADPKD, TRAE is clinically safe and effective, more studies with larger sample are needed to be conducted before its long-term effect can be clarified.(J Intervent Radiol, 2022, 31: 861-864)