超选择性肾动脉弹簧圈栓塞治疗经皮肾镜术后出血的临床研究

目的分析超选择性肾动脉弹簧圈栓塞术(SRACE)治疗经皮肾镜碎石取石术(PCNL)术后严重出血的时机选择、安全性和疗效。方法回顾性分析贵州省人民医院2013年10月至2019年3月38例PCNL后严重出血患者的出血特点、数字减影血管造影(DSA)表现及栓塞后肾功能检测情况。结果38例患者中,7例未观察到确切出血点,31例DSA表现为肾动脉性出血,其中动脉撕裂6例,单纯假性动脉瘤(PA)17例,动静脉瘘(AVF)4例,PA合并AVF 4例。根据肾脏血管解剖位置定位,肾动脉上极支出血4例,中极支出血9例,下极支出血18例。急性出血2例,其中1例经SRACE联合输血等治疗后未能有效控制出血而行患肾切除术,迟发性出血20例,缓慢持续性出血16例。31例患者中30例成功栓塞,成功率为96.8%。SRACE术前与术后的肾小球滤过率(P=0.173)、血清尿素氮(P=0.969)、血清肌酐(P=0.180)差异均无统计学意义(P>0.05)。结论急性出血应尽快行DSA明确诊断后行栓塞治疗,迟发性及缓慢持续性出血经保守治疗无效,DSA/SRACE可作为首选的检查方法及治疗方法,SRACE是安全有效的治疗方式。

Clinical study of super-selective renal artery coil embolization in the treatment of hemorrhage after percutaneous nephrolithotomy

ObjectiveTo analyze the timing, safety, and efficacy of superselective renal artery coil embolization (SRACE) in the treatment of severe hemorrhage after percutaneous nephrolithotomy (PCNL). MethodsThe bleeding characteristics, digital subtraction angiography (DSA) findings, and renal function detection after embolization of 38 patients with severe hemorrhage after PCNL in Guizhou Provincial People's Hospital from October 2013 to March 2019 were retrospectively analyzed. ResultsAmong the 38 patients, the exact hemorrhagic points were not observed in 7 cases and DSA of 31 cases showed renal arterial hemorrhage including 6 cases of arterial tear, 17 cases of simple pseudoaneurysm (PA), 4 cases of arteriovenous fistula (AVF), and 4 cases of PA in combination with AVF. According to anatomical locations of renal vessels, 4 cases of hemorrhage occurred in the superior pole branch of the renal artery, 9 cases in the middle pole branch, and 18 cases in the inferior pole branch. There were 2 cases of acute hemorrhage, among which 1 case received nephrectomy due to the failure of hemorrhage control after treatment with SRACE in combination with transfusion, 20 cases of delayed hemorrhage, and 16 cases of slow persistent hemorrhage. Embolization was successful in 30 of 31 patients, with a success rate of 96.8%. The differences of glomerular filtration rate, serum urea nitrogen, and serum creatinine before and after SRACE were not statistically significant (P>0.05). ConclusionFor acute hemorrhage, embolization treatment should be performed as soon as possible after definite diagnosis by DSA. When conservative treatment of delayed and slow persistent hemorrhage is ineffective, DSA/SRACE can be the preferred method for examination and treatment. SRACE is a safe and effective treatment.