超选择肾动脉栓塞术治疗经皮肾镜取石术后严重肾出血的临床应用  

Super-selective intrarenal embolization for severe renal hemorrhage followed by percutaneous nephrolithotomy

作　　者：孔鹏[1] 孟令平[1] 杨斌[1] 王家平[2] 童玉云[2] 

机构地区：[1]上海市第六人民医院金山分院放射科,上海金山201500 [2]昆明医科大学第二附属医院介入中心,云南昆明650101

出　　处：《昆明医科大学学报》2015年第6期85-88,共4页Journal of Kunming Medical University

基　　金：云南省科技计划项目(2009ZC111M);云南省教育厅科学研究基金资助项目(601090200506)

摘　　要：目的探讨超选择肾动脉栓塞术治疗经皮肾镜取石术（PCNL）后严重肾出血的临床应用价值.方法回顾分析2010年5月至2013年9月昆明医科大学第二附属医院应用SSIE治疗MPCNL术后严重肾出血60例患者的临床资料.采用Seldinger技术,经肾动脉造影后,行超选择性插管至出血的肾动脉分支,以明胶海绵、PVA颗粒和弹簧圈等栓塞剂行栓塞治疗.结果本组患者治疗后效果满意,无严重并发症发生.一次栓塞成功57例成功率为95%（95%CI86.08%-98.96%）;术后第1-4 d肉眼血尿消失;2例栓塞后再发出血经第2次栓塞血止.1例栓塞后仍继续出血,经第3次栓塞出血止;术后随访32例,平均37.4个月;患肾功能得到了最大程度的保护.结论选择性肾动脉栓塞术创伤小,止血效果好,能最大限度保留出血肾脏功能,可作为经皮肾镜取石术后肾出血的有效、安全的治疗方法.Objective To assess the value of Super- selective renal arterial embolization for severe renal hemorrhage followed by percutaneous nephrolithotomy.Methods SRAE was performed in 60 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data the way of embolization the medication and the follow- up findings were retrospectively analyzed.Results Restrospective analysis in May2010 to September 2013 in our application SSIE MPCNL postoperative treatment the clinical data of 60 patients with severe renal bleeding.The technical successful rate with single session was 97% 57/60.Gross hematuria disappeared within1- 4 days after the treatment.Two patients developed shock after renal embolization and had to receive,surgery after the shock was controlled.Three patients had a recurrence of hematuria the blood urine subsided after SRAE was employed again.A follow- up with a mean period of 37.4 months was carried out in 32 patients and the follow- up checkups showed that the renal function was well preserved in all patients.Conclusion Selective renal arterial angiography and embolization is reliable and effective in the diagnosis and treatment of kidney hemorrhage followed by PCNL and in keeping mainfunction of the kidney.

关 键 词：出血 超选择肾动脉栓塞术 经皮肾镜取石 

分 类 号：R815[医药卫生—放射医学]