超选择性肾动脉栓塞术治疗保守治疗无效的创伤性肾出血患者疗效观察  

The observation on the efficacy of super-selective renal artery embolization in the treatment of patients with traumatic renal hemorrhage who failed to respond to conservative treatment

作　　者：林力 郑卫荣 Lin Li;Zheng Weirong(Department of Vascular Tumor Interventional,Wenling First People′s Hospital,Wenling 317500,China)

机构地区：[1]温岭市第一人民医院血管肿瘤介入科,温岭317500

出　　处：《中国医师进修杂志》2022年第4期367-370,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨超选择性肾动脉栓塞术(SRAE)治疗保守治疗无效的创伤性肾出血患者的疗效。方法选取2018年5月至2020年5月温岭市第一人民医院收治的64例创伤性肾出血患者作为研究对象,均采用SRAE进行治疗,观察患者的临床疗效、血管造影表现、肾功能、并发症及术后输血率及肾脏保留率。结果 64例创伤性肾出血患者一次栓塞成功62例,成功率为96.88%(62/64)。经血管造影发现假性动脉瘤占46.88%(30/64)、肾动静脉瘘占29.69%(19/64)、假性动脉瘤合并肾动静脉瘘占9.38%(6/64)、造影剂外溢占14.06%(9/64)。所有患者均可见出血点,出现1、2及3个出血点的患者分别占73.44%(47/64)、20.31%(13/64)及6.25%(4/64);出血位于上、中、下极分别占18.75%(12/64)、37.50%(24/64)及43.75%(28/64)。术后第7天,血红蛋白水平高于术前[(91.79 ± 23.58) g/L比(90.45 ± 22.31) g/L],血肌酐水平低于术前[(82.97 ± 25.32) μmol/L比(84.57 ± 24.51) μmol/L],红细胞压积水平高于术前(0.272 ± 0.070比0.262 ± 0.068),差异均有统计学意义(P<0.05)。术后并发症总发生率为26.56%(17/64),肾脏保留率为100.00%(64/64),输血患者占39.06%(25/64)。结论采用SRAE治疗保守治疗无效的创伤性肾出血患者,能够起到良好的止血效果,且并发症发生率低,安全可靠,能够较好地保护肾组织功能。Objective To evaluate the efficacy of super-selective renal artery embolization(SRAE)in the treatment of patients with traumatic renal hemorrhage who failed to respond to conservative treatment.Methods A total of 64 patients with traumatic renal hemorrhage admitted to Wenling First People′s Hospital from May 2018 to May 2020 were selected as the study subjects.All patients were treated with SRAE,the clinical efficacy,angiographic performance,renal function,complications,postoperative blood transfusion rate and renal retention rate of the patients were observed.Results There were 62 cases among 64 cases with traumatic renal hemorrhage were successfully embolized once,with a success rate of 96.88%(62/64).By angiography,46.88%(30/64)of the patients had pseudoaneurysms,29.69%(19/64)had renal arteriovenous fistula,9.38%(6/64)had pseudoaneurysms complicated with renal arteriovenous fistula and 14.06%(9/64)had contrast extravasation.Bleeding points were observed in all patients,and the proportions of 1 bleeding point,2 bleeding points and 3 bleeding points were 73.44%(47/64),20.31%(13/64)and 6.25%(4/64),respectively.The proportions of upper,middle and lower bleeding points were 18.75%(12/64),37.50%(24/64)and 43.75%(28/64).On the 7th day after the surgery,the levels of hemoglobin(Hb)and haematocrit(Hct)were higher than those before surgery:(91.79±23.58)g/L vs.(90.45±22.31)g/L,0.272±0.070 vs.0.262±0.068;the level of serum creatinine(SCr)was lower than that before surgery:(82.97±25.32)μmol/L vs.(84.57±24.51)μmol/L,the differences were statistically significant(P<0.05).The total incidence of postoperative complications was 26.56%(17/64).The renal retention rate was 100.00%(64/64)and the proportion of blood transfusion patients was 39.06%(25/64).Conclusions SRAE can play a good hemostatic effect in patients with traumatic renal hemorrhage that failed to respond to conservative treatment.It is safe and reliable with a low incidence of complications,and can better protect renal tissue function.

关 键 词：肾动脉 栓塞 治疗性 肾出血 创伤性 治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学]