反复肾动脉造影在处理经皮肾镜碎石取石术后严重出血中的意义  

Necessity of repeated renal arteriography in the treatment of severe hemorrhage after percutaneous nephrolithotomy

作　　者：于泓远[1] 刘俊龙 崔小鲁[1] 董潇[1] 丁永学 刘贤奎[1] Yu Hongyuan;Liu Junlong;Cui Xiaolu;Dong Xiao;Ding Yongxue;Liu Xiankui(Department of Urology,the First Affiliated Hospital of China Medical University,Shenyang 110001,China;Department of Urology,Liaoyang Center Hospital,Liaoyang 111000,China)

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001 [2]辽阳市中心医院泌尿外科,辽阳111000

出　　处：《中华医学杂志》2021年第38期3152-3156,共5页National Medical Journal of China

摘　　要：为探讨反复肾动脉造影在处理经皮肾镜碎石取石术后严重出血中的必要性,回顾性分析中国医科大学附属第一医院泌尿外科于2010年8月至2020年7月经皮肾镜碎石取石术后严重出血患者的临床资料,总结分析27例进行2次以上肾动脉造影患者的治疗转归及随访情况。这27例反复行肾动脉造影的患者中,23例行2次、4例行3次,均诊断为肾血管性损伤,其中15例假性动脉瘤,4例肾动静脉瘘,8例假性动脉瘤合并肾动静脉瘘。诊断明确后均行肾动脉栓塞治疗,术后血尿、腰部不适症状随即缓解或消失。随访6个月至5年,无症状反复,肾功能与栓塞前相当。结果显示,反复肾动脉造影在经皮肾镜碎石取石术后合并严重出血患者的处置中具有重要意义,可辅助明确出血原因并给与恰当及时的治疗。In order to discuss the necessity of repeated renal arteriography in the treatment of severe bleeding after percutaneous nephrolithotomy,this study retrospectively analyzed the clinical data of patients with severe bleeding after percutaneous nephrolithotomy in the Department of Urology Surgery of the First Hospital of China Medical University from August 2010 to July 2020,summarily analyzing treatments,outcomes and follow-up results of 27 patients who were treated by renal arteriography more than twice.Of these 27 patients who underwent repeated renal arteriography,23 of them were treated by two times,4 by three times,all of whom were diagnosed as renal vascular injury.And 15 of them were diagnosed as pseudoaneurysm,4 of them renal arteriovenous fistula,and 8 of them pseudoaneurysm combined with renal arteriovenous fistula.After clear diagnosis,all these patients were performed with renal artery embolization,after which the symptoms of hematuria and lumbar discomfort were relieved or disappeared immediately.These patients were followed up from 6 months to 5 years,without corresponding symptoms recurring and with the renal function equivalent to that before embolization.The results showed that repeated renal arteriography was of great significance in the treatment of patients with severe bleeding after percutaneous nephrolithotomy,helping to clarify the cause of bleeding and giving appropriate and timely treatment.

关 键 词：泌尿系疾病 尿路结石 经皮肾镜碎石取石术 严重出血 肾动脉造影 

分 类 号：R699.2[医药卫生—泌尿科学]