经皮肾镜碎石取石术后并发肾动静脉瘘的诊断和治疗(附18例报告)  

Diagnosis and treatment of renal arteriovenous fistula after percutaneous nephrolithotomy(a report of 18 cases)

作　　者：于泓远[1] 董潇[1] 崔小鲁[1] 刘贤奎[1] 孔垂泽[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,辽宁沈阳110001

出　　处：《中国现代医学杂志》2015年第3期62-65,共4页China Journal of Modern Medicine

摘　　要：目的探讨经皮肾镜碎石取石术后并发肾动静脉瘘的诊断和治疗。方法回顾性分析2008年1月-2013年1月18例经皮肾镜碎石取石术后并发肾动静脉瘘的临床资料。结果本组病例的主要症状为术后患者持续性血尿,2例严重者并发失血性休克;均行肾动脉造影诊断为肾动静脉瘘;18例均行手术治疗,其中16例行介入栓塞治疗,2例行外科手术患肾切除;术后血尿、腰部不适症状随即缓解或消失,随访6个月~5年,症状无反复。结论经皮肾镜碎石取石术后并发肾动静脉瘘虽然少见,但如果出现,应及时处理;选择性肾动脉造影是其诊断的金标准,肾动脉栓塞具有微创、安全、效果好等优点,是治疗该病的一种安全有效的方法;对于出血严重、栓塞治疗无效者,应果断采取外科手术治疗切除患肾,挽救患者生命。【Objective】To evaluate the diagnosis and treatment of renal arteriovenous fistula after percutaneous nephrolithotomy. 【Methods】The clinical data of 18 cases, who had renal arteriovenous fistula after percutaneous nephrolithotomy between Jan. 2008 and Jan. 2013, were reviewed and analyzed.【Results】The main symptom of the patients was severe and persistent hematuria. Two cases had complication of severe hemorrhagic shock. All the cases were given selective renal angiography and proven to have renal arteriovenous fistula. 18 cases underwent surgical treatment, in which 16 patients received renal artery embolization, 2 patients had the involved kidney removed. The symptoms of hematuria and lumbar discomfort were immediately relieved or disappeared after operation. All the patients were followed up for 6 months to 5 years, whose symptoms did not reoccur.【Conclusions】Although renal arteriovenous fistula after percutaneous nephrolithotomy is rare, when it appears, should be treated in time. The gold standard of diagnosis is selective renal angiography. Renal artery embolization is a micro-injury, safe and effective surgery for the treatment of this disease. For the patients with severe bleeding or ineffective embolism treatment, the diseased kidney should be removed decisively to save the patient＇s life.

关 键 词：经皮肾镜碎石取石术 肾动静脉瘘 介入治疗 

分 类 号：R692.16[医药卫生—泌尿科学]