超选择性肾动脉栓塞术在经皮肾镜取石术后严重出血中的临床应用  

Clinical applying superselective renal artery embolization to management of severe hemorrhage following percutaneous nephrolithotomy

作　　者：刘应清 罗莉莉 陶凌松 王家伟 江雪峰 李林 石结武 郑杰 LIU Yingqing;LUO Lili;TAO Lingsong;WANG Jiawei;JIANG Xuefeng;LI Lin;SHI Jiewu;ZHENG Jie(Department of Urology,Wuhu No.2 People′s Hospital,Wuhu 241000,China)

机构地区：[1]芜湖市第二人民医院泌尿外科,安徽芜湖241000 [2]芜湖市第二人民医院超声科,安徽芜湖241000

出　　处：《皖南医学院学报》2020年第5期435-439,共5页Journal of Wannan Medical College

基　　金：芜湖市卫生健康委员会资助课题(2019C01)。

摘　　要：目的:探讨超选择性肾动脉栓塞术(SRAE)治疗经皮肾镜取石术(PCNL)后严重肾出血的临床特点、应用时机、效果及安全性。方法:回顾分析2009年11月~2019年11月应用SRAE治疗PCNL后严重肾出血13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,以明胶海绵和(或)微弹簧圈等栓塞材料行栓塞治疗。其中男性12例,女性1例,年龄44~82岁,平均(61.4±11.9)岁。出现严重出血时间为术后1~15 d,平均(4.2±4.1)d;血红蛋白下降最大差值17~101 g/L,平均(43.8±28.1)g/L,最低<70 g/L共6例。结果:本组患者治疗后效果满意。一次栓塞成功11例,成功率为84.6%(11/13)。术后2~5 d肉眼血尿消失。2例栓塞后再发出血,1例经第2次栓塞成功,另1例切除患肾。术后随访表明肾功能得到了保护。未出现严重并发症。结论:SRAE创伤小,止血效果好,能最大限度保留肾脏功能,可作为PCNL后严重出血的有效、安全的治疗方法。Objective:To investigate the clinical features of severe renal hemorrhage after percutaneous nephrolithotomy(PCNL),and assess the indications,efficacy and safety of superselective renal artery embolization(SRAE)in management of PCNL.Methods:Clinical data were reviewed in 13 patients complicated with severe renal hemorrhage after PCNL treated with SRAE between November 2009 and November 2019.All patients received renal artery angiography using Seldinger technique to obtain superselective intubation access to the branch of bleeding renal artery that was embolized with gelatin sponge or microcoil.Of the 13 patients,12 were males and 1 was female.The patients aged from 44 to 82 years,with an average of(61.4±11.9)years.Severe hemorrhage lasted from 1 to 15 days following surgery,and averaged(4.2±4.1)days.The maximum difference in hemoglobin decline ranged from 17 to 101 g/L,with an average of(43.8±28.1)g/L.Postoperative hemoglobin level below 70 g/L occurred in 6 cases.Results:SRAE was generally satisfied in this cohort,and successful in 11 cases at first attempt,with a success rate of 84.6%(11/13).Gross hematuria was absent by between day 2 and 5 after operation.Secondary hemorrhage after embolization occurred in two patients,in whom one was managed by repeated embolization,and another underwent nephrectomy.Postoperative follow-up indicated that the renal function was protected to the greatest extent,and no serious complications occurred.Conclusion:SRAE can be effective and safe technique for management of severe hemorrhage following PCNL because of its minor trauma,better hemostatic outcome and maximal protection of the kidney function.

关 键 词：超选择性肾动脉栓塞术 数字减影血管造影 肾出血 经皮肾镜取石术 无管化 

分 类 号：R692.4[医药卫生—泌尿科学] R699.2[医药卫生—外科学]