经皮置管溶栓治疗急性肾动脉栓塞的疗效评价  

Clinical evaluation of transcatheter thrombolytic therapy for acute embolic renal artery occlusion

作　　者：马羽佳[1] 刘兆玉[1] 郑加贺 张军[1] 赵健[1] MA Yu-jia LIU Zhao-yu ZHENG Jia-he ZHANG Jun ZHAO Jian(Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2016年第11期791-794,共4页Journal of China Clinic Medical Imaging

摘　　要：目的：评价经皮肾动脉置管溶栓治疗急性肾动脉栓塞的有效性及安全性。材料与方法：回顾性分析13例急性肾动脉栓塞并接受介入治疗的病例。所有患者首先进行DSA造影，判断病变性质、部位、范围，根据造影结果选择合适造影导管留置于肾动脉内，术后经导管泵入尿激酶溶栓治疗，每日复查肾动脉造影观察肾动脉再通情况。出院后定期随访。结果：所有患者均完成急诊肾动脉造影及置管，溶栓治疗过程持续24~120 h，应用尿激酶总量60万~300万单位，溶栓过程中无严重并发症发生。其中6例肾动脉主干及3例肾动脉分支栓塞患者治疗后血管再通，1例肾动脉主干及3例肾动脉分支栓塞患者疗效不佳。1例患者溶栓后发现肾动脉狭窄，置入1枚支架。所有患者在术后腰痛症状均有缓解，随访6~40月无复发。结论：经皮置管溶栓治疗能够有效恢复肾脏血流，缓解患者的临床症状，是急性肾动脉栓塞的一种安全有效的治疗手段。Objective： To evaluate the efficacy and safety of transcatheter local thrombolysis in treatment of acute embolic renal artery occlusion. Materials and Methods： A retrospective analysis of 13 patients with acute embolic renal artery occlusion and interventional treatment. In all patients, digital subtraction angiography（DSA） was performed to confirm the suspected diagnosis, followed by selective catheterization of the renal artery to identify the occlusion type. Thrombolytic therapy was performed by urokinase with regional catheter delivery by means of infusion pump, and renal artery angiography repeated daily. Regular follow-up after discharge. Results： All patients completed the emergency renal arteriography and catheterization, thrombolytic therapy process lasts 24 to 120 hours without any serious complications. The total amount of urokinase was 0.6 million units to 3 million units. Renal artery recanalization was achieved in 6 cases with the main renal artery embolization and 3 cases with renal artery branches embolization, and there was poor efficacy in 1 patient with main renal artery and 3 patients with renal artery branches embolization. One patient was found renal artery stenosis after thrombolysis, and a renal artery stent placement was performed. The flank pain symptoms were relieved in all patients. There was no recurrence during 6~40 months followed up. Conclusion： In acute embolic renal artery occlusion, transcatheter local thrombolysis is a safe and effective treatment which may recover renal blood flow effectively, relieve the symptoms of patients.

关 键 词：栓塞 胆固醇 肾疾病 血管造影术 数字减影 

分 类 号：R692.16[医药卫生—泌尿科学] R815[医药卫生—外科学]