创伤性肾出血的DSA诊断与介入栓塞治疗  

DSA for Diagnosis and Transcatheter Arterial Embolization for the Treatment of Traumatic Renal Hemorrhage

作　　者：李海平[1] 雷光武[1] 李刚[1] 王小宜[1] 赵金山[1] 李乔秀[1] 

机构地区：[1]湖南长沙中南大学湘雅医院放射科,410008

出　　处：《临床放射学杂志》2007年第11期1130-1132,共3页Journal of Clinical Radiology

摘　　要：目的评价创伤性肾出血的DSA诊断与介入栓塞止血治疗的临床应用价值。资料与方法48例创伤性肾出血患者均行肾动脉DSA检查,栓塞材料采用明胶海绵、聚乙烯醇(PVA)微粒或弹簧钢圈。结果48例肾内血管损伤患者经选择性或超选择性肾动脉造影均获得了明确的诊断,36例可见对比剂外溢;7例肾内受损动脉痉挛、移位,末梢血管不规则、毛糙、其中3例合并动-静脉瘘;5例肾内受损动脉分支中断、缺支,其中2例合并假性动脉瘤。6例单纯采用明胶海绵栓塞后,其中2例分别于术后7天、12天再发血尿,其余病例采用PVA微粒或弹簧钢圈栓塞均一次成功。所有患者肉眼血尿术后平均3天消失,平均随访18个月无肾出血复发,血尿素氮、肌酐及血压正常,静脉尿路造影见肾未栓塞部分肾功能正常,栓塞部分肾盏有不同程度变形。结论DSA是诊断创伤性肾出血的可靠方法,选择性肾动脉栓塞治疗创伤性肾出血微创、疗效好且迅速、并发症少,能最大程度保护损肾功能。选择恰当的栓塞材料可以减少复发率及异位栓塞。Objective To evaluate the clinical value of DSA for the diagnosis and transcatheter arterial embolization for the treatment of traumatic renal hemorrhage. Materials and Methods 48 patents with traumatic renal hemorrhage had renal artery digital subtraction angiography（DSA）. Embolization was performed with gelfoam, poly vinyl alcohol（PVA） particulate and spring steel coil respectively. Results All patients were confirmed by selective or super - selective renal arteriography. Contrast medium external eruption was observed in 36 cases. Injured renal artery twitched and shifted, and the distal vessels were irregular and foggy in 7 cases, 3 of which had arteviovenors fistula. The branches of injured renal artery were broken off and missing in 5 cases, 2 of which presented with false aneurysm. Hematuria occurred on the seventh day and the twelfth day respectively in 2 cases among 6 genlatin sponge-embolized cases. Other cases succeeded with embolization using poly vinyl alcohol particulate or spring steel coil. Hematuria ceased in 3 days on average. No recurrence of renal hemorrhage was found in 18 months. Blood creatinine, blood urea nitrogen and blood pressure were normal. The renal parenchyma without embolization worked normally while renal calyces of the embolized part were distorted under intravenous urography. Conclusion DSA is reliable for the diagnosis of traumatic renal hemorrhage. Selective renal arterial embolization for the treatment of traumatic renal hemorrhage is minimally invasive, effective, prompt with few of complications, and can preserve the function of traumatic renal mostly. Recurrence and embolization at the wrong place can be reduced by choosing right material for embolization .

关 键 词：肾创伤 数字减影 血管造影术 放射学 介入性 栓塞 治疗性 

分 类 号：R816.7[医药卫生—放射医学] R692[医药卫生—临床医学]