肾部分切除术后出血的数字减影血管造影表现及介入治疗疗效分析  

The characteristics of digital subtraction angiography and the analysis of the therapeutic effect of interventional therapy on hemorrhage after partial nephrectomy

作　　者：徐海峰[1] 朱旭[1] 陈辉[1] 刘鹏[1] 高钦宗 Xu Haifeng;Zhu Xu;Chen Hui;Liu Peng;Gao Qinzong(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Interventional Therapy Department,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所介入治疗科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华医学杂志》2021年第11期766-769,共4页National Medical Journal of China

基　　金：国家自然科学基金(81971717)。

摘　　要：目的探讨肾肿瘤行肾部分切除术(PN)后出血的数字减影血管造影(DSA)表现以及介入治疗的安全性和疗效。方法回顾性分析2015年1月至2019年1月北京大学肿瘤医院介入治疗科15例因PN后出血行急诊介入治疗患者的临床资料、DSA图像及介入治疗情况,归纳总结其DSA表现、介入治疗的安全性和预后。结果15例患者中,10例临床表现为腹腔出血,2例为腹腔出血同时伴血尿,3例为血尿,发生出血时间为术后6 h至7 d。DSA表现为造影剂外溢、局部动脉管壁不光整、局部动脉分支扩张、假性动脉瘤形成、肾动静脉瘘。14例存活病例,随访6~12个月,未再出现出血。接受介入治疗的14例患者操作全部成功(14/14),止血全部成功(14/14)。1例因术中恶心呕吐窒息死亡。术前、术后1周、术后1个月肌酐水平分别为(76.0±11.0)、(80.0±9.0)、(76.0±9.0)μmol/L。三组间肌酐水平差异无统计学意义(F=3.171,P=0.058)。术前、术后1周、术后1个月尿素氮水平分别为(6.80±1.04)、(7.13±0.89)、(6.81±0.79)μmol/L,三组间尿素氮水平差异有统计学意义(F=4.322,P=0.024)。术后1个月尿素氮水平比术后1周降低,差异有统计学意义(P=0.016),但与术前相比,差异无统计学意义(P=1.000)。结论造影剂外溢、假性动脉瘤形成、肾动静脉瘘为PN后出血的DSA主要表现。介入治疗在本组病例中安全有效,可以考虑在PN后出血情况下使用。Objective To investigate the digital subtraction angiography(DSA)manifestations of hemorrhage after partial nephrectomy(PN)for renal tumors,and the safety and efficacy of interventional therapy.Methods The clinical data,DSA images and interventional treatment of 15 patients undergoing emergency interventional therapy due to hemorrhage after PN in the Department of Interventional Therapy of Beijing University Cancer Hospital from January 2015 to January 2019 were retrospectively analyzed.The DSA manifestations,safety and prognosis of interventional therapy were summarized.Results Among the 15 patients,10 had abdominal hemorrhage,2 had abdominal hemorrhage with hematuria,and 3 had hematuria,all of which occurred 6 hours to 7 days after the operation.The DSA manifestations included contrast medium overflow,local artery wall unevenness,local artery branch expansion,pseudoaneurysm formation and renal arteriovenous fistula.There were 14 survivors,followed up for 6-12 months,and further no bleeding occurred.The success rate of interventional therapy was 100%(14/14),and the success rate of hemostasis was 100%(14/14).One patient died of asphyxia due to intraoperative nausea and vomiting.The creatinine levels were(76.0±11.0),(80.0±9.0),(76.0±9.0)μmol/L before operation,1 week after operation and 1 month after operation respectively.There was no significant difference in creatinine levels among the three groups(F=3.171,P=0.058).The levels of urea nitrogen before operation,1 week after operation and 1 month after operation were(6.80±1.04),(7.13±0.89),(6.81±0.79)μmol/L respectively.There was significant difference among the three groups(F=4.322,P=0.024).The level of urea nitrogen at 1 month after operation was significantly lower than that at 1 week after operation(P=0.016),but there was no difference compared with that before operation(P=1.000).Conclusion Contrast medium overflow,pseudoaneurysm formation and renal arteriovenous fistula were the main manifestations of DSA hemorrhage after PN.Interventional therapy was

关 键 词：肾切除术 出血 血管造影 介入治疗 

分 类 号：R737.11[医药卫生—肿瘤]