微创经皮肾镜取石术后严重出血的DSA诊断和介入治疗

目的 探讨肾结石微创经皮肾镜取石术(MPCNL)术后出血的肾动脉造影表现及超选择性肾动脉栓塞止血的价值.方法 回顾性分析48例肾结石MPCNL术后出血患者的临床与动脉造影资料,分析其肾动脉造影表现、栓塞治疗效果及并发症等.结果 肾动脉造影结果显示MPCNL后出血的原因:单纯假性动脉瘤25例(52.1%)、假性动脉瘤伴动静脉瘘6例(12.5%)、假性动脉瘤伴对比剂外渗1例(2.1%)、肾动静脉瘘11例(22.9%)、血管破裂对比剂外渗2例(4.2%)和包膜动脉曲张1例(2.1%),未发现异常2例(4.2%).46例接受了栓塞治疗,并达到了栓塞治疗成功的DSA标准和临床标准,其中采用聚乙烯醇颗粒(PVA)栓塞18例、PVA+钢圈栓塞5例、明胶海绵栓塞10例、明胶海绵+钢圈栓塞11例、PVA+明胶海绵+钢圈栓塞2例.栓塞后均出现不同程度的栓塞后综合征;术后血清肌酐较术前轻度升高12例.结论 超选择性肾动脉栓塞能有效止血和保存肾脏功能,是MPCNL术后严重出血的首选治疗方法.

Diagnosis and treatment of severe hemorrhage following minimally invasive percutaneous nephrostolithotomy

Objective To investigate the renal angiographic manifestations of severe hemorrhage following minimally invasive pereutaneous nephrostolithotomy (MPCNL), and to evaluate the technique of super-selective renal arterial embolization in treating the condition. Methods Forty-eight cases of severe hemorrhage following MPCNL treated with super selective renal arterial embolization in our department were retrospectively reviewed. The angiographic findings, results and complications of embolization procedures were analyzed. Results Two cases were of acute hemorrhage immediately after MPCNL, and the other 46 cases were of delayed hemorrhage 2 to 7 days after MPCNL. Of these 48 cases, 25 (52.1%) showed simple pseudo-aneurysms, 6 (12.5%) pseudo-aneurysms accompanied with arterial-venous shunts, 1 (2.1%) pseudo-aneurysm with extravasated contrast medium, 11 (22.9%) arterial-venous fistulas, 2 (4.2%) extravasated contrast medium from arterial branches, 1 (2.1%) renal capsular branches varix, 2 (4.2%) no lesion detected. Successful super-selective embolization was achieved in all 46 positive cases, and renal hemorrhage was stanched consequently. Polyvinyl alcohol foam embolization particles (PVA), gelfoam and coils were used in the procedures (PVA in 18 procedures, PVA +coil in 5, gelfoam in 10, geffoam + coil in 11, PVA + gelfoam + coil in 2). Post-embolization syndrome of various degrees were seen in all treated patients. A slight rise in blood creatinine levels was observed in 12 cases. Conclusion Super selective renal arterial angiography and embolization is the treatment of choice in patients who suffered severe hemorrhage due to MPCNL.