急诊选择性肾动脉栓塞治疗外伤性肾出血

目的 探讨外伤性肾出血的急诊选择性肾动脉栓塞治疗的效果和价值。方法 外伤性肾出血患者23例，临床症状：腹痛、血尿或酱黄色尿，心率快、血压低，11例出血性休克，其中5例血压测不出；12例伴多脏器伤。7例急诊科直接送导管室，5例手术室转送导管室，11例保守治疗3～75小时无效而行肾动脉栓塞治疗。采用seldinger法，经股动脉入路，选择性肾动脉血管造影和栓塞治疗，栓塞材料为明胶海绵。结果 23例经血管造影诊断：肾破裂13例、肾内血肿6例、肾横断3例、肾粉碎1例。出血肾动脉28支，其中：19例1支肾动脉、3例2支、1例3支。6例伴腹膜后巨大血肿者12支腰动脉及1支髂内动脉参与出血，给予栓塞，对伴骨盆骨折7例同时行10支髂内动脉栓塞。栓塞治疗后出血即刻停止，血压平均回升11／5kPa，血尿于术后0．5～3天停止，尿液变清。3例多脏器伤死于脏器衰竭。门诊随访，15例健康存活，3例经静脉肾盂造影证实，部分肾功能存在。5例失访。结论 外伤性肾出血采用急诊选择性肾动脉栓塞术，疗效显著，是一种积极、有效、简单、快速、安全的止血措施，而选择、超选择性插管栓塞治疗，能最大限度保留肾脏功能。

Emergency selective arterial embolization therapy of traumatic renal hemorrhage

Objective To evaluate the effect and the value of emergency selective arterial embolic treatment for traumatic renal hemorrhage.Methods There were 23 cases with traumatic renal hemorrhage. The main symptoms included abdominal pain, hematuria or dark-brown-yellow-colored urine, rapid heart rate, hypotension. 11 cases suffered hemorrhagic shock.Blood pressure of 5 cases couldn't be detected. 12 cases accompanied with multiple organ injury. 7 cases were sent to duct-room directly from the department of emergency. 5 cases were sent to duct-room from surgery. 11 cases underwent renal arterial embolization therapy after conservative therapy 3~75 hours was of no effect. We used Seldinger method: selective arterial angiography and embolization therapy from femoral artery. Embolization material was gelfoam. Results 23 cases underwent angiographic exam and diagnosis was confirmed. In 23 cases,there were 13 cases with renal rupture, 6 cases with renal hematoma, 3 cases with transection injury, 1 case with renal crush. Bleeding renal artery had 28 branches, including one branch(19 cases), two branches (3 cases), three branches ( 1 case). 6 cases accompanied with huge retroperitoneal hematoma had twelve lumbar artery and one iliaca internal artery bleeding and embolized 7 cases which accompanied with pelvic facture were embolized 10 iliaca internal artery. Bleeding quickly stopped after embolization. Blood pressure recovered 11/5kPa averagely. Hematuria disappeared in 0.5~3 days and urine became clear. 3 cases with multiple organ injury died due to organ failure. After followed up, 15 cases are alive health. Confirmed by IVP, 3 cases part kidneys's function were kept. 5 cases were out of followed.Conclusions Emergency selective arterial embolization is active, effective, simple, quick, safe measure for treating hemorrhage. Selective and superselective renal arterial embolization therapy can keep kidneys' function most.