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。

Superselective renal artery embolization for the treatment of traumatic renal hemorrhage

Objective To assess the value of transcatheter superselective arterial embolization in treatment of renal traumatic hemorrhage. Methods 20 patients underwent digital subtraction angiography with definite diagnosis before embolization. Embolization materials used in the study were gelfoam sponge chips and steel coils including 14 cases of segmental arteries with their branches through superselective renal arterial embolization. 6 cases were treated by selective renal arterial embolization. Results After renal artery embolization, macroscopic hematurin disappeared on 3th to 5th day after the procedure. With an average of 29 months of follow-up, there was no recurrent hemorrhage associated with normal renal function and blood pressure. Conclusions Superselective renal arterial embolization has advantages of less aggression, less complications, and good hemostatic efficacy, with maximal preservation of renal tissue and function for treatment of mild and moderate renal injuries.