医源性肾损伤超选择性肾动脉栓塞的临床疗效及相关因素分析  

Clinical Efficiency of Superselective Renal Artery Embolization for Treatment Iatrogenic Renal Injury

作　　者：张孝军[1] 韩世龙[1] 许云飞[2] 曹传武[1] 张家兴[1] 郑军华[2] 李茂全[1] 

机构地区：[1]上海同济大学附属第十人民医院介入科,200072 [2]上海同济大学附属第十人民医院泌尿外科,200072

出　　处：《临床放射学杂志》2013年第4期562-565,共4页Journal of Clinical Radiology

摘　　要：目的探讨影响超选择性肾动脉栓塞术治疗医源性肾损伤的临床疗效及预后的相关因素。方法 10例医源性肾损伤患者,均为男性,平均年龄47.4岁。术后发病时间最长60天,最短1天,平均3天。临床均表现为肉眼血尿,其中9例经皮肾镜取石术后,1例为肾病经皮穿刺活检术后。经CT检查见肾实质出现征象,行统一标准的肾脏数字血管造影,表现为对比剂外溢或动静脉瘘,明确出血血管后,行超选择性肾动脉栓塞。术前1天和术后5天分别检测肾功能,并行配对t检验。结果 10例患者均成功进行损伤靶血管的栓塞术,9例表现为对比剂外溢征象,1例表现为动静脉瘘;9例为下极动脉,1例为上极动脉。栓塞后即刻造影,责任动脉未见对比剂外溢或静脉早现。术后随访1～24个月,无再发肉眼血尿,栓塞术后肉眼血尿消失时间最长者7天,最短1天,平均2.2天。肾功能较术前显著改善(P=0.03),无严重并发症。结论超选择肾动脉栓塞术治疗医源性肾损伤出血安全、有效。Objective To analyze the clinical efficiency of superseletive renal artery embolization for treatment iatrogenic renal injury. Methods Ten males, with average of 47.4 - year - old, suffered from iatrogenic renal injury underwent superselective renal artery embolization. Renal function was tested 1 day before and 5 days after the embolization. Results Nine patients had received percutaneous nephrolithotomies and 1 patient with had received percutaneous kidney biopsy. The patients presented with persistent hematuria for 1 to 60 days, with an average of 3 days, after nephrostomy or percutaneous biopsy. CT images and renal angiography showed bleeding in kidney parenchyma, contrast agent extravasation in pa renchyma（ n = 9）, arteriovenous fistula（ n = 1 ）. There was no recurrent gross hematuria during the follow -up of 1 to 24 months. Hematuria disappeared after 1 day, with an average of 2.2 days, after embolization. The renal function was improved significantly （P = 0.03 ） without severe complications. Conclusion Superselective renal artery embolization for treatment of iatrogenic renal injury is safe and effective.

关 键 词：医源性 肾损伤 栓塞 疗效 

分 类 号：R692[医药卫生—泌尿科学]