医源性肾动脉损伤性出血的介入诊疗

目的探讨超选择性动脉造影与栓塞治疗医源性肾动脉损伤性出血的临床价值。方法对11例肾穿刺活检或经皮肾镜取石术后大量肉眼血尿患者实施超选择性肾动脉造影与栓塞术,栓塞材料采用明胶海绵与弹簧圈。结果 11例中,假性动脉瘤2例,动-静脉瘘2例,假性动脉瘤合并动静脉瘘5例,动脉-肾盏瘘2例;损伤血管为肾脏后段、下段动脉及其叶间动脉分支,单支血管损伤10例,多支血管损伤1例。单纯采用明胶海绵栓塞4例,单纯采用弹簧圈栓塞4例,二者联合栓塞3例,其中1例为明胶海绵栓塞24h后复发尿血改用弹簧圈栓塞。栓塞后10min造影示出血征象消失,1~3天后患者血尿逐渐消失,未发生严重并发症。结论动静脉瘘为医源性肾动脉损伤的主要表现,以单发病变多见;超选择性动肾脉造影可迅速明确诊断,超选择性肾动脉栓塞微创、安全、有效,应作为治疗医源性肾动脉损伤性出血的首选方法。

Interventional diagnosis and treatment for hemorrhage from iatrogenic renal artery injure

Objective To explore the value of interventional diagnosis and treatment for hemorrhage from iatrogenic renal artery injure. Methods A total of 11 patients with massive hemorrhage after renal biopsy or percutaneous nephroscope lithotripsy, underwent super-selective renal angiography and embolization. Embolization materials were gelfoam and coil. Results In 11 cases, angiography showed 2 cases of pseudoaneurysm, 2 cases of arterio-venous fistula (AVF), 5 cases of pseudoaneurysm combined with AVF, 2 of artery-renal calices fistular. Injured vessels included posterior segment, inferior segment and interlobar renal artery, there were more than one vessels injured in 10 patients and single vessel injured in one. Embolization was carried on using gelfoam in 4 cases, coil in 4 cases and both in 3 cases, one case was embolized using added 1 coil for hemorrhage again 24 h after gelfoam embolization. Ten minutes later, angiography showed the features of hemorrhage disappeared, hematuria disappeared gradually in 3 days, and no severe complications occurred. Conclusion AVF is main vascular signs in patients with iatrogenic renal artery injure, and single lesion is common. Super-selective renal artery angiography can rapidly obtain definite diagnosis. Super-selective renal artery embolization is safe, effective and has minimal invasion in treating hemorrhage from iatrogenic renal artery injure, should be the preferred method.