医源性肾血管损伤出血的介入治疗

目的评价应用血管内栓塞技术治疗医源性肾血管损伤出血的安全性和疗效。 方法对34例医源性肾血管损伤出血患者进行了超选择性肾动脉栓塞治疗。损伤原因有肾脏穿刺活检术后14例，肾部分切除术后8例，经皮肾镜碎石术后8例，经皮肾盂造瘘术后3例，经皮氩氦刀术后1例。栓塞材料包括微钢丝圈、氰基丙烯酸正丁酯碘油混合物、聚乙烯醇微球、明胶海绵碎粒。 结果选择性肾动脉造影显示肾实质假性动脉瘤21例，肾动静脉瘘8例，肾实质破裂造影剂外溢10例。栓塞技术成功率为100%，治疗结束时复查造影显示异常血管消失,正常分支保留。30例患者栓塞后失血症状改善，栓塞后30天内出院，4例患者术前伴失血性休克，栓塞后10天内死亡。30例患者随访5～48个月均未再出血，也未出现其他严重并发症，16例死于原发疾病。 结论经导管选择性肾动脉分支栓塞术是治疗医源性肾血管损伤出血安全有效的方法。

Transarterial embolization in treatment of iatrogenic renal hemorrhage

ObjectiveTo evaluate the safety and efficacy of interventional techniques for emergent treatment of iatrogenic renal vascular injuries. MethodsThirty-four patients with iatrogenic renal vascular injuries were treated with transarterial embolization (TAE). A total of 14 had history of renal biopsy, 8 had partial nephrectomy, 8 had percutaneous nephrolithotomy (PCNL), 3 had percutaneous nephrostomy (PNT), and 1 had percutaneous argon-helium knife. The embolic materials include metallic coils, N-butyl cyanoacrylate (NBCA) iodized oil mixture, polyvinyl alcohol particles (PVA) and gelfoam were used. ResultsRenal angiogram revealed the pseudoaneurysm in 21 cases, the arteriovenous fistula in 8 cases, and contrast media extravasation in 10 cases. The successful rate of technical was 100%. Medical successes were achieved in 30 patients, and discharged in 30 days later after the embolizations. Four patients died in 10 days later after the embolizations, and all of them accompanied with hemorrhagic shock. Follow-up time ranged from 5—48 months, all of the 30 patients have no re-bleeding and other serious complications, but 16 patients died of primary disease. ConclusionsTAE is a safe and effective treatment method for iatrogenic renal vascular injuries.