微创经皮肾镜取石术后肾出血的造影诊断和介入治疗

目的探讨微创经皮肾镜取石术后肾出血的造影表现及介入治疗方法。方法对42例微创经皮肾镜取石术后肾出血患者行肾动脉造影和超选择性动脉栓塞,术前、术后检查肾功。结果术前造影表现为单纯假性动脉瘤19例,假性动脉瘤伴动静脉瘘15例,造影剂外溢4例,阴性4例。24例钢圈栓塞,13例明胶海绵颗粒加钢圈栓塞,1例PVA栓塞,4例用明胶海绵栓塞,栓塞成功率100%。明胶海绵栓塞后复发1例。术前、术后检查肾功无明显变化。结论肾动脉造影及超选择动脉栓塞对诊断和治疗微创经皮肾镜取石术后肾出血效果优良,对内科治疗无效、造影阴性病例,按穿刺部位超选择诊断性动脉栓塞,可起到止血作用。

Angiography diagnosis and interventional treatment of renal hemorrhage after minimal invasive percutaneous nephrolithotomy

Objective To explore the angiographic manifestations and interventional treatment of renal hemorrhage after minimal invasive percutaneous nephrolithotomy(MPCNL).Methods Forty two patients with renal hemorrhage after MPCNL received renal arteriography and ultraselective arterial embolization.Their renal function before and after the operation was examined.Results The renal arteriography before the operation showed simple pseudo-aneurysm in 19 cases,pseudo-aneurysm associated with arteriovenous fistula in 15 cases,extravasation of contrast media in 4 cases and negative imaging in 4 cases.Twenty four patients received the embolization by steel ring;13 patients received the embolization by steel ring plus particles of gelatin sponge;1 patient received the PVA embolization and 4 patients received the embolization by gelatin sponge.The total achievement ratio of the embolization was 100%.Recurrence occurred in one case after the embolization by gelatin sponge.There was no change in the examination of renal function before and after the operation.Conclusion The renal arteriography and ultraselective arterial embolization have good effects on the diagnosis and treatment of renal hemorrhage after MPCNL.For those cases that achieved no curative effects in medical treatment and were negative in the arteriography,ultraselective diagnostic arterial embolization can effectively stop bleeding.