超选择性肾动脉栓塞治疗创伤性肾出血

目的 探讨超选择性肾动脉栓塞治疗创伤性肾出血的应用价值。方法 20例创伤性肾出血患者在数字减影血管造影下,采用明胶海绵或(和)钢丝圈进行肾动脉栓塞。14例患者损伤在肾动脉一级分支以下,作超选择性肾动脉栓塞;6例患者肾动脉分支主干损伤或无法进行超选择性肾动脉栓塞者,作肾动脉主干或一级分支主干栓塞。结果 所有患者术后3～5d肉眼血尿消失。平均随访29个月,无肾出血复发,血尿素氮、肌酐及血压正常。术后复查：超选择性肾动脉栓塞治疗组,患肾未栓塞部分肾功能恢复,肾外形基本正常;非超选择性肾动脉栓塞治疗组,2例患肾无功能,4例患肾部分肾功能恢复。肾外形明显缩小。结论超选择性肾动脉栓塞术创伤小、疗效好、并发症少,能最大限度保护病肾功能,是治疗Ⅰ型、Ⅱ型闭合性肾损伤出血的安全有效方法。     

超选择性肾动脉栓塞治疗肾损伤出血临床应用

目的 研究创伤性肾出血在保守治疗无效情况下进行动脉栓塞的造影表现及栓塞方法。方法 采用超选择性肾动脉栓塞术治疗25例肾损伤患，所有病人在栓塞前都进行肾动脉造影证实诊断。栓塞材料用明胶海绵加金属钢圈。结果 24例病人经栓塞后，临床症状很快得到缓解，1个月后进行静脉尿路造影检查，伤侧肾功能恢复。1例栓塞后仍持续性血尿行肾切除。结论 对创伤性肾出血病人，采用肾功脉栓塞具有止血效果好、能最大限度保护肾功能、减少并发症，是一种治疗肾损伤的安全有效方法。     

超选择性肾动脉栓塞治疗肾损伤出血72例

超选择性肾动脉造影栓塞术为肾损伤性出血开辟了一种行之有效的微创诊疗途径.我院自1990年3月至2007年12月采用超选择性肾动脉栓塞术治疗肾损伤性出血72例,效果满意.     

超选择性动脉栓塞治疗顽固性鼻出血

目的 评价超选择性动脉栓塞治疗顽固性鼻出血的临床应用价值.方法 27例经常规治疗无效的顽固性鼻出血患者,采用Seldinger技术,将导管超选择性插管至颈外动脉分支内,造影证实出血部位后,采用明胶海绵颗粒或/和聚乙烯醇(PVA)颗粒行动脉栓塞治疗.结果 27例顽固性鼻出血患者均发现出血动脉,栓塞治疗全部成功,术后即刻拔除鼻腔填塞物,出血停止,未见严重并发症.结论 超选择性动脉栓塞术治疗顽固性鼻出血是一种安全有效的治疗方法,值得临床推广应用.     

选择性肾动脉栓塞治疗肾错构瘤(附16例报道)

目的:探讨选择性肾动脉栓塞治疗肾错构瘤的疗效。方法:对16例患者共18个错构瘤分别采用平阳霉素、明胶海绵颗粒混合物(13例)及平阳霉素、超液化碘油混合液(5例)两种方法进行栓塞,最后采用弹簧圈阻塞供血动脉主干。分析介入治疗的疗效和并发症等。结果:所有患者于栓塞术后临床症状、体征迅速改善,术中、术后无严重并发症产生。术后3个月、6个月及1年随访,治疗有效率为100%。结论:选择性肾动脉栓塞治疗肾错构瘤是一种安全、有效治疗方法。     

选择性肾动脉栓塞治疗肾损伤出血的临床应用

目的 分析选择性肾动脉栓塞治疗肾损伤出血的疗效和安全性。资料与方法 1992年7月至2005年6月,39例肾脏损伤性出血患者,其中肾脏外伤28例,医源性损伤11例,采用金属弹簧圈行选择性肾动脉栓塞术。结果 DSA证实损伤部位位于肾段或段以下肾动脉分支,全部患者术后1～4d肉眼血尿消失（除2例再次栓塞外）,随访4个月～2年,无复发性血尿,无并发症出现。结论 选择性肾动脉栓塞治疗肾损伤出血创伤小、安全、疗效确切,能避免肾脏外科手术。     

选择性肾动脉栓塞治疗损伤性肾出血

目的观察选择性肾动脉栓塞治疗急性损伤性肾出血的疗效。方法回顾性分析2008年6月—2011年12月32例损伤性肾出血行选择性肾动脉栓塞治疗情况,其中包括肾挫裂伤18例,肾部分切除术术后出血2例,经皮肾镜术后出血12例。结果 31例患者一次栓塞成功,1例患者栓塞术后第5天再次出血行第2次栓塞术后血尿消失。术后随访2~40个月,未见肾出血再发,1例出现肾周尿液囊肿;2例肾脏体积缩小,该2例均为Ⅴ级肾挫裂伤患者。随访期间无肾脓肿、肾性高血压及肾功能异常发生。结论选择性肾动脉栓塞是治疗急性损伤性肾出血微创、有效、安全的治疗方法。     

经导管栓塞或药物灌注治疗胃肠道出血

目的 探讨动脉栓塞或药物灌注术在胃肠道动脉性出血疾病中的临床疗效及应用价值.方法 21例胃肠道出血患者均行肠系膜动脉和腹腔动脉造影,对其中16例明确出血动脉的患者,再超选择插管造影并栓塞治疗.栓塞材料为明胶海绵颗粒12例,明胶海绵颗粒+弹簧圈4例.另5例未发现出血动脉,用垂体后叶素灌注治疗.结果 21例中16例造影为阳性征象,表现为对比剂外溢7例,动脉杵状扩张、扭曲、回流静脉早显5例,肿瘤染色伴出血4例.21例治疗后出血停止,20例随访3～30个月均未再出血,1例栓塞后第4天再次出血,行外科手术治疗.本组无1例肠缺血、肠坏死等并发症发生.结论 经导管栓塞或药物灌注治疗胃肠道动脉性出血疗效确切,安全、创伤小、并发症少,值得临床进一步推广应用.     

经导管液体加压法联合导丝再通治疗输卵管阻塞性不孕症(附72例报告)

目的 探讨液体加压法联合导丝再通治疗输卵管阻塞性不孕的价值.方法 对72例(124条输卵管)输卵管阻塞性不孕症患者,在电视监视下利用液体加压法以及导丝再通术进行输卵管再通治疗.术后抗炎及定期输卵管通液治疗.结果 采用液体加压法达到复通的输卵管共59条,采用液体加压法及导丝再通达到复通的输卵管为50条.液体加压法联合导丝再通治疗输卵管阻塞再通成功率可达87.9%.无严重并发症发生.术后1年内对72例患者进行跟踪随访,怀孕27例,达37.5%.结论 液体加压法联合导丝再通术是治疗输卵管阻塞性不孕的一种有效的微创方法.     

超选择性动脉插管栓塞治疗急性动脉性出血

目的探讨超选择性动脉插管栓塞治疗急性动脉性出血的方法和临床应用价值。方法47例动脉性出血的病人行超选择性出血动脉插管栓塞治疗。包括肿瘤性出血15例,非肿瘤性出血32例。出血量500~2800ml。结果44例患者应用动脉栓塞治疗达到止血目的。近期有效率93.67%。无严重并发症发生。随访3~12个月,2例复发。结论超选择性动脉插管栓塞治疗急性动脉出血、止血安全有效。     

产后大出血超选择性动脉插管栓塞治疗研究

产后大出血死亡率较高 ,传统保守治疗成功率低 ,手术治疗创伤大并发症多 ,而且永久丧失生育能力。经皮穿刺超选择动脉插管栓塞 ,为治疗产后大出血开辟了一条新途径。本组报道超选择性动脉栓塞治疗产后大出血 18例 ,并讨论其疗效、安全性及并发症。1　材料和方法本组 18例 ,年龄 2 1～ 2 6岁 ,平均 2 3岁。产道撕裂 6例 ,子宫收缩乏力 3例 ,胎盘碎片滞留 4例 ,剖宫产后子宫切口裂开 5例。出血量 2 0 0 0～ 40 0 0ml ,平均 3 2 0 0ml ,出血时间 4～ 16h。 6例处于休克状态。行改良Seldinger前壁穿刺经右股动脉插入5F -Cobra导管 ,插至左髂内…     

医源性肾损伤超选择性肾动脉栓塞的临床疗效及相关因素分析

目的 探讨影响超选择性肾动脉栓塞术治疗医源性肾损伤的临床疗效及预后的相关因素.方法 10例医源性肾损伤患者,均为男性,平均年龄47.4岁.术后发病时间最长60天,最短l天,平均3天.临床均表现为肉眼血尿,其中9例经皮肾镜取石术后,1例为肾病经皮穿刺活检术后.经CT检查见肾实质出现征象,行统一标准的肾脏数字血管造影,表现为对比剂外溢或动静脉瘘,明确出血血管后,行超选择性肾动脉栓塞.术前1天和术后5天分别检测肾功能,并行配对t检验.结果 10例患者均成功进行损伤靶血管的栓塞术,9例表现为对比剂外溢征象,1例表现为动静脉瘘;9例为下极动脉,1例为上极动脉.栓塞后即刻造影,责任动脉未见对比剂外溢或静脉早现.术后随访1～24个月,无再发肉眼血尿,栓塞术后肉眼血尿消失时间最长者7天,最短1天,平均2.2天.肾功能较术前显著改善(P=0.03),无严重并发症.结论 超选择肾动脉栓塞术治疗医源性肾损伤出血安全、有效.     

Renal Cell Carcinoma in a Horseshoe Kidney and Preoperative Superselective Renal Artery Embolization: A Case Report

Only rarely is renal cell carcinoma encountered in a horseshoe kidney. This is a case report on renal cell carcinoma in a horseshoe kidney, in which superselective renal artery embolization was performed preoperatively. CT and digital subtraction angiography revealed a horseshoe kidney with a 3-cm tumor in the left side. Superselective renal artery embolization of the tumor was performed as a prerequisite procedure for the organ-preserving surgery of simple enucleation. Preoperative superselective renal artery embolization can be an effective tool to facilitate organ-preserving surgery in a horseshoe kidney.     

超选择性肾动脉栓塞的临床应用

目的　研究肾动脉栓塞术在肾损伤出血及肾肿瘤术前的临床应用。方法　对 83例进行超选择性肾动脉栓塞 ,其中 5 7例为肾肿瘤 ,2 6例为肾出血 ,应用明胶海绵碎屑及金属圈 ,栓塞肿瘤血管及出血动脉。结果　肾肿瘤术中易剥离 ,出血少 ,术野清晰、术时缩短 ;肾出血 2 6例 ,除 1例肾切除外 ,其余的出血均停止。结论　肾动脉栓塞有助于肾肿瘤的手术切除。对肾损伤出血者 ,可降低手术率 ,最大限度保存肾脏     

Crural Artery Traumatic Injuries: Treatment with Embolization

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15–56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1–180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.     

血管栓塞治疗胃十二指肠动脉大出血(附5例报告)

胃十二指肠动脉大出血是上消化道出血原因之一 ,血管栓塞治疗是经导管行动脉造影 ,寻找出血动脉的同时进行相应出血动脉栓塞。具有操作简便 ,疗效迅速可靠的优越性。本文报道胃十二指肠动脉出血 5例 ,进行了血管栓塞治疗 ,取得了很好的疗效。1　典型病例介绍例 1　患者 ,女 ,72     

Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization

The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 ± 10.3 h (range, 0.2–34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection and localization of arterial renal hemorrhage and appropriate for guidance of the embolization procedure.     

超选择肾动脉多材料栓塞治疗PCNL术后肾出血的临床应用

目的 探讨经皮肾镜取石(PCNL)术后肾出血的血管造影诊断和采用多种材料进行肾动脉栓塞治疗的临床应用价值.方法 搜集2011年2月至2015年3月PCNL术后肾出血患者共27例,均予肾动脉造影,根据造影情况分别行超选择多材料栓塞治疗[栓塞材料采用明胶海绵、聚乙烯醇(PVA)、弹簧圈及无水乙醇].术后总结造影表现及进行患者随访,观察其疗效及安全性.结果 27例患者中26例血管造影呈阳性改变,其中动静脉瘘12例、假性动脉瘤11例.26例造影结果阳性者均成功进行栓塞治疗(其中2例进行了第2次栓塞),另1例造影阴性者予以术中灌注止血药,术后所有患者均出血停止,随访6个月未见有复发出血及严重并发症发生.结论 血管造影能明确PCNL术后肾出血原因,超选择肾动脉多材料栓塞具有安全、高效、并发症少等优点,其止血效果显著,对PCNL术后肾出血治疗有重要临床价值.