经皮肾镜取石术后肉眼血尿的超选择性动脉栓塞治疗  

Superselective Arterial Embolization for the Treatment of Gross Hematuria Concurrent Postoperative Percutaneous Nephrolithotomy

作　　者：贺祥[1,2] 张和平[1,2] 靳海英[1,2] 张杰[1,2] 王晓宏[1,2] 王长福[1,2] 李长坡[1,2] 刘岩[1,2] 

机构地区：[1]河南大学淮河医院影像科 [2]河南大学医学影像研究所,开封475000

出　　处：《临床放射学杂志》2012年第11期1625-1628,共4页Journal of Clinical Radiology

摘　　要：目的探讨经皮肾镜取石术(PCNL)后无痛性肉眼血尿的原因及经导管超选择性插管肾动脉栓塞治疗(KAE)的方法和疗效。方法共7例PCNL后持续性全程无痛性肉眼血尿患者,男5例,女2例,年龄38～64岁,平均52岁。PCNL后3～5天,左肾2例,右肾5例,7例患者均有持续性全程无痛性肉眼血尿,血压难以维持。治疗方法:采用Seldinger穿刺技术进行股动脉穿刺插管,做选择性患侧肾动脉造影,检出出血原因后超选择性插入供血动脉,用医用明胶海绵颗粒或弹簧钢丝圈栓塞靶血管,栓塞后立即造影复查。结果 7例患者均发现有肾动脉分支假性动脉瘤(RAP),其中2例合并动静脉瘘(AVF);7例患者经栓塞治疗后出血停止,血压恢复正常。栓塞前后肾功能无显著变化。结论 DSA检查是确诊PCNL后全程无痛性肉眼血尿原因的较好办法,PCNL后全程无痛性肉眼血尿的直接原因主要是肾动脉分支RAP和AVF,KAE是治疗PCNL后RAP及AVF的安全性高、疗效肯定的治疗方法。Objective To investigate the reasons of gross hematuia concurrent postoperative percutaneous nephrolithotomy,and the effect of superselective intubation arterial embolization.Methods 7 cases of percutaneous nephrolithotomy with gross hematuria were selected.5 cases of males and 2 cases of females,age 38-64 years old,average age 52 years,3-5 days after percutaneous nephrolithotomy,2 cases of the left kidney,right kidney in 5 cases,7 patients had persistent whole painless gross hematuria and were difficult to maintain blood pressure.Puncture femoral artery using the Seldinger puncture technique was used to make a selective ipsilateral renal angiography,the causes of bleeding was detected,and then target vessel was embolized using medical gelatin sponge particles or spring steel wire coil,angiography was repeated immediately after embolization.Results 7 cases were found to have renal artery branch pseudoaneurysm,and 2 cases with arteriovenous malformation.The bleeding was stopped in these 7 cases after embolization,and the blood pressure returned to normal.Conclusion DSA is a good method to confirm the reasons of whole painless gross hematuria after percutaneous nephrolithotomy.The reasons mainly include renal artery branch pseudoaneurysm and arteriovenous fistula.Catheter superselective cannulation of renal artery embolization（KAE） is the safe and effective method in treatment of pseudoaneurysm aneurysms and arteriovenous fistula after percutaneous nephrolithotomy.

关 键 词：肉眼血尿 肾动脉 假性动脉瘤 动静脉瘘 动脉造影 栓塞治疗 

分 类 号：R699[医药卫生—泌尿科学]