经皮肾镜取石术后重复肾动脉造影原因分析  

Reason analysis of repeated renal arteriography after percutaneous nephrolithotomy

作　　者：何朝辉[1] 雷汉祺 王航涛 任医民[2] 伍筱梅[2] 曾国华[1] 

机构地区：[1]广州医科大学附属第一医院泌尿外科,广州510120 [2]广州医科大学附属第一医院介入放射科

出　　处：《临床泌尿外科杂志》2015年第11期985-987,共3页Journal of Clinical Urology

摘　　要：目的：总结分析经皮肾镜取石术（PNCL）后需重复行肾动脉造影＋超选择性肾动脉栓塞术（SRAE）的原因。方法：我院2001年8月--2015年8月PCNL术后有369例患者共行427次肾动脉造影＋SRAE，其中有21例需重复行2次以上肾动脉造影＋SRAE。本研究对其临床资料进行回顾性分析，记录其造影所见。结果：21例患者中，12例行2次、5例行3次、1例4次、3例行5次。肾动脉造影＋SRAE。重复进行的37例次再次行肾动脉造影术发现7例为遗漏动脉瘤，5例为栓塞血管再通；22例发现新的血管损伤病变，其中16例发现新的动脉瘤，2例发现新的动静脉瘘，4例发现新的动脉瘤和动静脉瘘混合病变；3例术中未发现明显病变。结论：PCNL术后重复行肾动脉造影＋SRAE的原因除病变遗漏、栓塞血管再通外，发现新的血管病变是主要原因。引起新的血管病变的原因不明，可能与出血引起肾动脉灌注压过高，加重了原肾动脉小的损伤有关。Objective：To summarize the reasons of repeated renal arteriographies and super-selective renal ar- tery embolization （SRAE） after PCNL. Method：We retrospectively reviewed the computerized data of 369 patients who received repeated renal arteriography and SRAE after PCNL from August 2001 to August 2015 in our hospi- tal. A total of 427 renal arteriographies and SRAEs were performed in 369 patients who had underwent PCNL. Re- suit： Of 21 patients needed repeated renal arteriography. Among them, 12 required 2 sessions of renal arteriogra- phies and SRAEs, 5 required 3 sessions, 1 required 4 sessions and 3 required 5 sessions. In all 37 repeated renal ~teriographies, missed pseudoaneurysm was found in 7, repatency of embolized vessel found in 5, new renal vas- cular injury was found in 22, including new pseudoaneurysm in 16, new AVF in 2, combination of new pseudoan- eurysm and AVF in 4, and no identified abnormity was found in 3. Conclusion： Besides the omitting of abnormal vessel and repatency of embolized vessel, the findings of new renal vascular injury are the main reasons of repeated arteriographies after PCNL. The cause of new renal vascular injury is unidentified, but it may be related to the deterioration of intrinsical vessel injury caused by high renal pelvic pressure.

关 键 词：经皮肾镜取石术 肾动脉造影 超选择性肾动脉栓塞术 

分 类 号：R692.4[医药卫生—泌尿科学]