超选择性肾动脉栓塞治疗经皮肾镜取石术后严重出血  

Super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy

作　　者：钟百书[1] 张胜[1] 彭志毅[1] 周先勇[1] 许平[1] 袁夏风[1] 

机构地区：[1]浙江大学医学院附属第一医院放射科,310003

出　　处：《中华泌尿外科杂志》2012年第1期41-43,共3页Chinese Journal of Urology

摘　　要：目的评价超选择性肾动脉栓塞治疗PCNL后严重出血的效果及其对肾功能的影响。方法2008年5月至2010年2月，7例MPCNL术后严重出血患者，男5例，女2例。年龄28—68岁，中位年龄55岁。结石单发2例，多发5例，其中铸型结石2例。结石位于下组肾盏4例，中组肾盏1例，上组肾盏2例，肾盂和输尿管上段4例。患者术后平均10．7d出血，出血持续1—14d，总出血量600～1800ml。实验室检查：SCr77—186μmol／L，平均94μmol／L；BUN2．58—8．03mmol／L，平均4．85mmol／L。行超选择性肾动脉造影和弹簧钢圈栓塞治疗。结果肾动脉造影示假性动脉瘤6例，其中合并动静脉瘘1例；未显示出血灶1例。6例均成功地进行了肾动脉弹簧钢圈栓塞治疗，术后3～7d出血停止。术后2周复查SCr为59～98μmol／L，平均78．3μmol／L，BUN为1．86～6．92mmol／L，平均4．80mmol／L。结论超选择性肾动脉栓塞治疗PCNL术后严重出血效果显著，肾功能受损轻，是临床首选的治疗手段。Objective To evaluate the outcome of super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy （PCNL） and its effect on renal function. Methods From May 2008 to Feb 2010, severe bleeding occurred in 7 patients after PCNL in our hospital. （5 males and 2 females, average age of 54.9 years）. All cases were treated with superelective renal angiography and 6 cases underwent microcoil embolization. Results Renal angiography showed pseudoaneurysm in 5 cases, pseudoaneurysm with arteriovenous fistula in 1 case and no severe bleeding in 1 case. Successful coil embolization was confirmed in 6 cases by angiography, and bleeding stopped within 3 -7 days after embolization. Serum creatinine and blood urea nitrogen were 59 -98 μmol/L（ mean, 78.3 μmol/L） and 1.86 - 6.92 mmol/L（mean, 4.8 mmol/L） 2 weeks after embolization, respectively. Conclusions Super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy has the advantages of remarkable hemostatic effects and mild impaired renal function, which is of the first choice.

关 键 词：经皮肾镜取石术 出血 栓塞 介入放射学 

分 类 号：R699[医药卫生—泌尿科学]