超选择性肾动脉栓塞治疗经皮肾镜取石后肾出血的临床研究

Clinical Research of Superselective Renal Embolization for Severe Renal Hemorrhage after mPCNL

目的探讨超选择性肾动脉栓塞(SRAE)治疗经皮肾镜取石(mPCNL)后肾出血的临床治疗效果.方法 287例mPCNL术后肾出血患者,采用Seldinger技术,经肾动脉造影寻找肾动脉损伤的部位及损伤程度,行超选择性插管至肾动脉出血部位,选用弹簧钢圈+乙烯醇颗粒栓塞或弹簧钢圈+明胶海绵进行肾动脉栓塞.结果 282例患者DSA造影阳性,5例患者DSA造影阴性.257例患者经1次栓塞后停止出血;26例患者第1次栓塞后再发出血,经第2次栓塞后止血;1例栓塞后仍继续出血,经第3次栓塞出血停止;3例患者栓塞后未止血,行开放性手术,其中1例行肾切除,2例行肾修补术后止血.上述患者止血后随访6~12个月,无血尿复发、脓肾、肾性高血压病例.1例长期高血压并肾萎缩,行外科肾切除后血压恢复正常.结论超选择性肾动脉栓塞术为mPCNL后出血提供了一种快速有效止血地方法、并很好的保留了患侧肾功能、减轻患者痛苦,提高患者生活质量,同时也为临床开展mPCNL提供有力保障.

Objective The purpose of this study was to evaluate superselective renal arterial embolization(SRAE) in treating severe renal hemorrhage after mPCNL. Methods SRAE was performed in 287 patients with severe renal hemorrhage after mPCNL by using Seldingers method. Using coil and PVA microspheres or coil and gelatin foam, renal arterial embolization was performed. Before embolization, the renal artery angiography could judge the region and degree of arterial injury. Res ults Two hundred and eighty-two patients artery angiography were positive, and 5 patients artery angiography were negative. After SRAE with single session, the hemorrhage stopped in 257 patients. 26 patients had a recurrence of hematuria, and the blood urine subsided after SRAE was employed again. The blood urine subsided in 1 patient after the third embolization. 3 patients still bled after renal embolization and had to receive surgery. The 6-12 months follow-up was carried out in all patients. There was no haematuia relapses or pyonephrosis occurring. After nephrectomy, blood pressure of 1 patient with a long term hypertension and renal atrophy returned to normal. Conclus ion Superselective renal artery catheterization and embolization can maximally preserve renal function and save lives, is a rapid and safe treatment for severe renal hemorrhage aftermPCNL. It can provide an effective guarantee for the development of mPCNL.