NBCA 胶超选择栓塞治疗经皮肾镜取石术后大出血  

Super-selective embolization for severe hemorrhage after percutaneous nephrolithotomy with N-butyl cyanoacrylate

作　　者：谢坪[1] 李刚[1] 程美雄[1] 张天[1] 

机构地区：[1]四川省医学科学院四川省人民医院放射科,四川成都610072

出　　处：《实用放射学杂志》2014年第8期1367-1369,1375,共4页Journal of Practical Radiology

摘　　要：目的：分析经皮肾镜取石术（PCNL）术后出血肾动脉造影表现,探讨应用 NBCA 胶经导管超选择栓塞治疗术的有效性及安全性。方法对14例 PCNL 术后肾出血患者,实施肾动脉造影并使用 NBCA 对病变动脉行超选择性栓塞。回顾性分析其临床资料以了解 PCNL 术后肾动脉损伤位置、类型、栓塞结果,评价栓塞术的技术成功率、临床疗效及手术相关并发症。结果血管造影表现为：假性动脉瘤12例,其中3例伴动脉肾盏瘘,5例伴动静脉瘘。单纯动静脉瘘2例。14例患者均成功使用 NBCA 行超选择性动脉栓塞术。NBCA 用超液化碘油按1︰2~1︰4比例稀释,术中 NBCA 混合剂用量0.1~0.2 mL。手术成功率100%。术后出血症状消失,无再出血病例,无器官坏死并发症。结论假性动脉瘤是 PCNL 术后大出血肾动脉损伤最常见的异常表现,使用 NBCA 胶经微导管超选择栓塞治疗安全、有效。Objective To analyze the manifestation of renal artery angiography and discuss the effectiveness and safety of super-selective embolization using N-butyl cyanoacrylate （NBCA）for severe hemorrhage after percutaneous nephrolithotomy （PCNL）. Methods Renal angiography and super-selective embolization with NBCA were performed in 14 patients for severe hemorrhage after PCNL.A review of medical charts were performed to gather information regarding the site,and type of bleeding lesions,and the result of the embolization procedure.The technical and medical success,and technical and medical complications of the procedure were evaluated.Results Renal angiography revealed pseudoaneurysm in 12 cases,including 3 cases with arterial fistula calyx,5 cases with arteriovenous fistula,and simple arteriovenous fistula in 2 cases.14 patients were successfully performed by super-selective embolization .NBCA and iodized oil was mixtured at a 1 ︰ 2-1 ︰ 4 ratio,0.1-0.2 mL of NBCA with lipiodol was used for each procedure.Technical succes rate was 100%.In all cases,hemorrhage stopped .No ischemic necrosis of organ,and no recurrence of renal hemorrhage were seen.Conclusion Pseudoaneurysm is the most common abnormal manifestation of renal artery hemorrhage af-ter PCNL.Super-selective embolization of the renal artery with NBCA is a safe and feasible procedure .

关 键 词：造影术 栓塞术 经皮肾镜 出血 

分 类 号：R815[医药卫生—放射医学] R692.4[医药卫生—临床医学]