选择性肾动脉栓塞治疗肾脏出血疾病

目的探讨选择性肾动脉栓塞治疗肾脏出血疾病的临床价值。方法对15例肾脏出血疾病患者进行选择性肾动脉栓塞,其中肾外伤性出血1例,肾动静脉畸形出血6例,肾癌术前栓塞6例,肾癌姑息治疗2例,采用明胶海绵颗粒及金属弹簧钢圈,栓塞肿瘤血管及出血动脉,肾癌姑息治疗选用化疗药+碘油的乳化剂、明胶海绵栓塞。结果 1例肾外伤性出血患者,栓塞治疗后24h肉眼血尿消失,随访6个月血尿再无复发。6例肾脏动静脉畸形出血患者,栓塞治疗1～3d后,肉眼血尿消失,3～7d尿显微镜检查正常,随访6～18个月均无血尿复发。6例肾癌术前栓塞患者,肾肿瘤术中易剥离,出血少,手术时间缩短,术后康复快。2例肾癌姑息治疗患者,栓塞治疗后24h肉眼血尿消失,分别3个月、6个月后CT复查病灶缩小,延长生存期。结论选择性肾动脉栓塞是治疗肾脏出血疾病的一种安全、有效的方法,创伤小,止血迅速,并发症少,能最大限度保存肾脏。中、晚期肾癌术前栓塞肾动脉有助于改善肾癌手术条件,减少术中出血,提高手术成功率。

Selective Renal Artery Embolization for the Treatment of Renal Hemorrhage Disease

Objective To discuss the clinical value of the selective renal artery embolization for the treatment of renal disease.Methods 15 patients with renal hemorrhage were treated by selective renal artery embolization,including 1 case of renal trauma bleeding,6 cases of renal arteriovenous malformation hemorrhage,6 cases of preoperative embolization of renal cell carcinoma,2 cases of renal palliative care.Gelatin sponge particles and metal spring steel ring were used,tumor blood vessels and arterial embolism,palliative treatment of renal cell carcinoma were selected the methods of chemotherapy + lodized oil emulsifier,gelatin sponge embolization.Results 1 case of traumatic renal hemorrhage,the naked eyes could see the disappearance of gross hematuria after 24 h for the treatment of embolization.The patient was followed up for 6 months,no hematuria recurred.6 cases of renal arteriovenous malformation hemorrhage,after 1 ～ 3 d for the treatment of embolization,the naked eyes could see the disappearance of hematuria.The microscopic examination was normal after 3 ～ 7 d.The patients were followed up for 6 to 18 months,no hematuria recurred.6 cases of preoperative embolization of renal cell carcinoma,kidney tumor during surgery was easy to peel,and it had less bleeding,shorter operative time and quick recovery.2 cases of renal palliative care,the naked eyes could see the disappearance of hematuria after 24 h for the treatment of embolization.After 3,6 months,through the review of CT,lesions were minified and the lifetime could be prolonged.Conclusion Selective renal artery embolization is a safe and effective method of treating renal hemorrhage disease,it has low trauma,rapid hemostasis,less complications and can save the kidney in maximum.The preoperative renal artery embolization of middle and late renal cell carcinoma can help to improve the conditions of kidney cancer surgery,reduce bleeding and improve the success rate of the surgery.