20例肾病综合征合并肾静脉血栓的介入性溶栓治疗

目的 探讨经皮选择性肾动脉内注射肾上腺素的肾静脉造影法对肾静脉血栓形成的诊断效果及留置肾动脉、肾静脉导管，区域性溶栓对肾病综合征(NS)合并肾静脉血栓的治疗作用。方法 20例NS经肾静脉造影确诊有肾静脉血栓形成的患者在激素及免疫抑制剂等治疗基础上，用介入性经皮穿刺，将导管插入到肾动脉及肾静脉，固定后给尿激酶冲击继而予微泵以维持量持续7～14d区域灌注溶栓治疗。结果 20例区域溶栓患者，溶栓后7—14d浮肿及腹水消退、尿量增加、尿蛋白减少、肾功能改善。随访并继续常规方法治疗3-9个月，15例完全缓解，5例部分缓解，无明显出血等副反应。结论肾动脉、静脉留置导管区域灌注尿激酶方法溶栓效果好，可提高NS治疗缓解率。

Interventional thrombolysis for nephrotic syndrome having renal venothrombogenesis in 20 patients

[Objective] To evaluate the diagnostic efficacy of renal venography by percutaneous selective endoarterial injecting adrenine to renal venothrombogenesis(RVT), and the therapeutic effect to complicated venothrombi nephrotic syndrome(NS) by maintaining renal arterial or venous catheter, and focal thrombolysis. [Methods] Twenty patients diagnosed as having RVT by venography treated with hormone and immunosuppressor, were treated with interventional percutaneous cannulation. The catheter was cannulated to renal artery or vein and retained there. Urokinase was injected profusely at first and then maintenance dose was given through a micro pump for 7 to 14 days. [Results] Edema, ascites, and proteinuria decreased, urination increased and renal function ameliorated after local thromboclasis for 7 to 14 days. There after the patients treated with traditional methods for 3 to 9 months. 15 cases recovered completely with 5 partial recovery no adverse reaction (e.g.bleeding) manifested. [Conclusion] Thromboclasis by infusing urokinase into renal vessels is effective to escalate the rate of remission. Therefore the method is valuable for wide clinical practice.