13例医源性肾血管损伤性出血的介入治疗  

Interventional therapy of iatrogenic renal blood vessel injury hemorrhage in 13 cases

作　　者：于洋[1,2] 刘灵军 崔天蕾[1,2] 李肖[2,4] 付平 YU Yang;LIU Lingjun;CUI Tianlei;LI Xiao;FU Ping(Department of Nephrology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041;Center of Interventional Diagnosis and Treatment,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China;Department of Radiology,West China Second Hospital,Sichuan University,Chengdu,Sichuan 610041,China;Department of Intervention Therapy,National Cancer Center/Tumor Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021.China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]四川大学华西医院介入诊疗中心,成都610041 [3]四川大学华西第二医院放射科,成都610041 [4]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院介入治疗科,北京100021

出　　处：《重庆医学》2018年第22期2940-2942,2947,共4页Chongqing medicine

摘　　要：目的探讨急诊介入治疗在医源性肾血管损伤性出血中的安全性和疗效。方法回顾分析2008年1月至2015年6月经DSA诊断及介入治疗的肾医源性损伤出血患者的临床资料及疗效,其中经皮肾镜取石术后7例,肾活检术后5例,部分肾脏切除术后1例。结果 13例患者中有12例经选择性肾动脉造影明确诊断,其中11例患者行超选择肾动脉分支栓塞术,2例患者行肾动脉覆膜支架植入术,平均随访27.9个月,无肾出血复发。结论超选择性血管内栓塞治疗可作为保守治疗无效的医源性肾血管损伤性出血的首选治疗手段,对无法行超选择肾动脉分支栓塞治疗的患者,肾动脉覆膜支架植入术是一种有效的急诊替代治疗手段。Objective To investigate the safety and effect of emergency interventional therapy in iatrogenic renal blood vessel injury hemorrhage.Methods The clinical data and curative effects in the patients with renal iatrogenic injury hemorrhage diagnosed by digital subtraction angiography（DSA）and treated by interventional therapy were retrospectively analyzed,including 7 cases of percutaneous nephrolithotomy,5 cases of post-renal biopsy and 1 case of partial nephroctomy.Results Among 13 cases,12 cases were definitely diagnosed by selective renal angiography.Eleven cases conducted super selective renal arterial branch embolization,and 2 cases conducted renal arterial covered stent implantation.Follow up lasted for average 27.9 months without no renal hemorrhage recurrence.Conclusion Super selective endovascular embolization can serve as the first choice treatment means for iatrogenic renal hemorrhage after invalid conservative treatment.For the patients can not conduct the super selective renal arterial branch embolization,renal arterial covered stent implantation is an effective emergency alternative treatment means.

关 键 词：肾脏 损伤 出血 医源性 并发症 血管内栓塞术 支架置入术 

分 类 号：R692.16[医药卫生—泌尿科学]