介入置管溶栓治疗肾动脉血栓栓塞  

Catheter-Directedthrombolysis(CDT) in the Treatment of Renal Artery Embolism

作　　者：何世明[1] 宋进华[2] 顾建平[2] 

机构地区：[1]南京市溧水人民医院放射科,211200 [2]南京医科大学附属南京第一医院介入科,210006

出　　处：《临床放射学杂志》2015年第6期976-979,共4页Journal of Clinical Radiology

基　　金：国家科技部"十一五"科技支撑计划资助项目(编号:2007BA105B04)

摘　　要：目的探讨介入置管溶栓治疗肾动脉血栓栓塞的方法及临床价值。方法 10例肾动脉血栓栓塞患者,经螺旋CT和血管造影明确诊断,均为一侧肾动脉血管栓塞。首先导丝穿通血栓,并将导管置入肾动脉血栓内,经导管团注尿激酶25万U,然后留置导管经输液泵持续尿激酶溶栓治疗1-3天,术后24、48、72 h行肾动脉造影复查,如果造影明确肾动脉重新开通,则予拔除留置导管。结果 9例患者患侧肾动脉成功开通,腰腹痛等临床症状迅速缓解。1例患者溶栓治疗72 h,肾动脉主干未能有效开通,远端分支血运有所好转,改行外科取栓术。所有病例6个月随访时肾动脉均保持通畅,在抗凝、溶栓治疗过程中未出现脏器出血及相关性死亡等严重并发症。结论置管溶栓术治疗肾动脉栓塞缓解症状迅速有效、微创、并发症较少,可以起到挽救肾脏的作用。Objective To evaluate the clinical value of the Catheter-directedthrombolysis（ CDT） in the treatment of renal artery embolism. Methods 10 patients with renal artery embolism were confirmed with spiral computed tomography（ CT） and angiography. All cases were lateral renal artery embolization. First the guide-wire was inserted and pushed forward to pass through the thrombus,then bolus injection of urokinase（ 250,000 units） through catheter was performed. Transcatheter micro-pump continuous infusion of urokinase（ 20,000- 40,000 units /24h） was employed for 1- 3 days until the thrombosis was completely dissolved,which was confirmed by angiography re-examination at 24,48 and 72 hours. Results The renal artery in 9 cases were proved to reopen by treatment and the waist pain quickly relieved. 1 cases failed to open the renal artery trunk 72 h after the thrombolysis treatment,the blood flow of the distal branches was improved and successfully treated by surgery. All renal arteries were kept patency during follow-up in next 6 month. No major complications occurred and no patients died of complications related to the procedures. Conclusion For the treatment of renal artery embolism,CDT is a effective,minimally invasive,safe and less complications technique which could increase to keep the fuction of the kidney.

关 键 词：接触性溶栓 肾动脉 血栓栓塞 放射学 介入性 

分 类 号：R692.16[医药卫生—泌尿科学] R816.7[医药卫生—外科学]