肾穿刺活检术后大出血原因及救治方案探讨  

Risk Factors of Severe Hemorrhage Following Percutaneous Renal Biopsy and Exploration of Therapy Method

作　　者：刘宏[1] 童俊容[1] 王妍春[1] 罗正茂[1] 

机构地区：[1]广州军区广州总医院肾内科,广东广州510010

出　　处：《华南国防医学杂志》2011年第2期119-121,共3页Military Medical Journal of South China

基　　金：广东省医学科研基金项目(B2008149)

摘　　要：目的探讨肾穿刺活检术后大出血的原因及最佳救治方案,为临床诊疗提供借鉴。方法分析作者医院2000/2010年1700例次超声引导经皮肾穿刺活检术中,3例肾脏大出血患者的临床病例特点与高危因素,探讨最佳救治方案。结果肾穿刺活检术后大出血发生率1.76‰。2例患者肾活检术前有长期高血压病史,术前行血液透析治疗,3例患者病理均为增生硬化型肾炎。例1经积极内科救治后病情稳定。例2接受切开直视手术后出血反复,后切除患肾,行维持性透析治疗。例3行数字减影血管造影后成功进行病变血管栓塞治疗,术后肾功能维持术前状态。结论术前高血压病史,较高的血肌酐水平,硬化性肾脏病变是肾活检后大出血的高危因素。对保守治疗无效者,数字减影肾动脉造影+超选择性栓塞介入治疗是最佳诊疗选择。Objective To evaluate the risk factors of severe hemorrhage following renal biopsy and assess the most effective therapy method.Methods In 1700 cases,3 cases with severe renal bleedings after kidney biopsies performed under real-time ultrasonograph guidance were studied.The clinical material were reviewed,the risk factors were analysed,and different therapy methods and outcomes were compared.Results The incidence of severe renal bleeding following renal biopsy was 1.76‰.Case 1 and 2 had hypertension for a long time and controlled well before biopsies.They both accepted hemodialysis.After bleeding,case 1 was recovered under internal medicine treatment;case 2 underwent surgeries twice and nephrectomy finally,resulting in total loss of renal function;case 3 underwent successful embolization after digital subtraction angiography（DSA） and his renal function remained stable.Conclusion Hypertension history,high serum creatinine levels and nephritic sclerosis are risk factors for severe hemorrhage after rental biopsy.Superselective embolization plus rental artery DSA is the most effective treatment method.

关 键 词：肾脏穿刺活检 大出血 肾动脉造影 栓塞 

分 类 号：R691.6[医药卫生—泌尿科学]