经皮肾镜取石术后肾出血的选择性肾动脉造影和栓塞治疗

目的 观察经皮肾镜取石术(PCNL)后肾出血的DSA影像学表现及超选择性动脉栓塞治疗的疗效.方法 收集PCNL术后肾出血经保守治疗无效患者12例,经选择性肾动脉造影检查,明确诊断后行超选择性肾动脉栓塞治疗,评价疗效. 结果 12例患者中,单纯假性动脉瘤8例,假性动脉瘤伴动静脉瘘2例,假性动脉瘤伴对比剂外溢2例,选用明胶海绵、真丝线段、聚乙烯醇微粒和微弹簧圈等栓塞材料成功进行栓塞,随访6个月均未发现再出血.2例患者出现栓塞后综合征,1例血清肌酐略升高,给予对症处理后症状逐渐好转.结论 选择性肾动脉造影可明确诊断PCNL术后肾出血;栓塞治疗迅速、安全有效、并发症少、可最大限度保护肾功能,是PCNL术后肾出血保守治疗无效的首选治疗方法.

Selective renal angiography and embolization for renal hemorrhage after percutaneous nephrolithotomy

Objective To investigate the angiographic manifestations of renal hemorrhage and the clinical effect of superselectve arterial embolization in treating renal hemorrhage of percutaneous nephrolithotomy (PCNL). Methods Twelve patients with renal hemorrhage after PCNL who had failed to respond to the conservation treatment were diagnosed definitely by selective renal arterioraphy. Super-selective renal artery embolization was performed in all patients after diagnosis. The efficacy was evaluated. Results In 12 patients, the angiographic manifestation showed that simple false aneurysm was in 8 patients, pseudoaneurysm combined with arteriovenous fistual was in 2 patients, pseudoaneurysm associated with contrst extravasation was in 2 patients. All patients underwent successful embolization by gelatin sponge, silk thread, PVA particles or micro-coil. No rebleeding was found in 6-month follow-up. Two patients had varying degrees of post-embolish syndrome, and serum creatinine level of 1 patient slightly increased after operation, which was gradually improved after symptomatic treatment. Conclusion Selective renal arteriography and embolization can be used as a method for renal hemorrhage after PCNL, which has the advantages of rapid clear diagnosis, safe and effective, less complications, and can also protect the renal function.