C臂CT引导的穿刺活检联合动脉栓塞在高出血风险肾肿物诊疗中的应用  

Application of C-arm CT-guided percutaneous puncture biopsy combined with arterial embolization in the diagnosis and treatment of renal mass with high bleeding risk

作　　者：孙占国 闫焱[2] 方毅[1] 刘一铭 许凯豪 韩新巍[1] 焦德超[1] SUN Zhanguo;YAN Yan;FANG Yi;LIU Yiming;XU Kaihao;HAN Xinwei;JIAO Dechao(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450050,China)

机构地区：[1]郑州大学第一附属医院放射介入科,河南郑州450050 [2]郑州大学第一附属医院肿瘤科,河南郑州450050

出　　处：《介入放射学杂志》2023年第3期262-265,共4页Journal of Interventional Radiology

摘　　要：目的 探讨C臂CT引导的肾穿刺活检联合肾动脉栓塞在高出血风险肾肿物诊疗中的安全性和有效性。方法 回顾性分析2011年1月至2021年10月郑州大学第一附属医院介入科行C臂CT引导的肾穿刺活检同步肾动脉栓塞术17例患者的临床资料。均于C臂CT引导的肾穿刺活检同步肾动脉栓塞术后24 h内,完成血常规和凝血功能检查,并与术前指标对比。结果 17例患者中,男11例,女6例,年龄为(66.5±7.0)岁。所有患者均为影像学诊断为肾癌,14例出现远处转移,3例因严重合并症无法耐受手术。高出血风险原因:9例有心脑血管疾病合并症需行抗血小板或抗凝治疗且无法停药,8例合并严重的凝血功能障碍。17例患者均成功取材,病理结果示16例为肾透明细胞癌,1例为乳头状肾细胞癌。术中15例患者出现肾动脉出血需行栓塞辅助治疗,均成功止血。术前术后血红蛋白、红细胞比容、血肌酐、血尿素氮比较,差异均无统计学意义(t=1.97、0.77、0.57、-0.88,均P>0.05)。结论 C臂CT引导的肾穿刺活检联合肾动脉栓塞是一种安全有效的方法。Objective To analyze the safety and effectiveness of C-arm CT-guided percutaneous puncture biopsy combined with arterial embolization in diagnosing and treating renal mass with high-risk bleeding.Methods The clinical date of a total of 17 patients with renal mass,who were admitted to the First Affiliated Hospital of Zhengzhou University of China between January 2011 and October 2021 to receive C-arm CT-guided percutaneous puncture renal biopsy with simultaneous renal artery embolization,were retrospectively analyzed.Blood routine and coagulation testing were performed within 24 hours after the treatment,the results were compared with the preoperative values.Results The 17 patients included 11 males and 6 females,with a mean age of(66.5±7.0)years.All patients suffered from imaging-proved renal carcinoma,14 patients had distant metastasis and 3 patients could not tolerate the surgery due to severe complications.The reasons of high bleeding risk included cardiovascular and cerebrovascular diseases which required antiplatelet or anticoagulant treatment and the medication could not be stopped(n=9),and coexisting severe coagulation disorders(n=8).Successful sampling of biopsy was accomplished in all 17 patients.Pathological diagnosis included renal clear-cell carcinoma(n=16)and papillary renal cell carcinoma(n=1).During the procedure,15 patients developed renal artery hemorrhage,the bleeding was successfully stopped after adjunctive renal artery embolization therapy.There were no significant differences in the levels of hemoglobin(t=1.97,P=0.09),erythrocrit(t=0.77,P=0.45),creatinine of blood(t=0.57,P-0.58)and blood urea nitrogen(t=-0.88,P-0.39)between their preoperative values and postoperative ones.Conclusion C-arm CT-guided percutaneous renal puncture biopsy combined with renal artery embolization is a safe and effective method.

关 键 词：肾肿物活检 出血 C臂CT 肾动脉栓塞 

分 类 号：R692.9[医药卫生—泌尿科学]