个体化超选择肾动脉栓塞在肾脏损伤性出血中的临床应用  

Clinical application of individualized superselective renal artery embolization in renal injury hemorrhage

作　　者：王文亮 魏宁 刘洪涛 吕墩涛 黄乾鑫 蒋明明 徐浩 祖茂衡 WANG Wenliang;WEI Ning;LIU Hongtao;LYU Duntao;HUANG Qianxin;JIANG Mingming;XU Hao;ZU Maoheng(Department of Interventional Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院介入放射科,江苏徐州221002

出　　处：《医学影像学杂志》2023年第7期1215-1219,共5页Journal of Medical Imaging

摘　　要：目的探讨个体化超选择肾动脉栓塞在肾脏损伤性出血治疗中的临床应用价值。方法选取肾脏损伤性出血的36例患者的资料,根据不同的出血类型、临床表现及造影表现,采用不同的栓塞时机及不同的栓塞剂组合方案,探讨个体化栓塞方法并观察疗效。结果单纯假性动脉瘤31例,共32枚,单纯聚乙烯醇(PVA)颗粒栓塞治疗2例,医用胶栓塞治疗1例,医用胶联合微弹簧圈栓塞治疗1例,微弹簧圈联合明胶海绵颗粒栓塞治疗27例;假性动脉瘤伴肾动静脉瘘2例,采用微弹簧圈联合明胶海绵颗粒栓塞;假性动脉瘤伴对比剂外溢3例,采用明胶海绵颗粒或联合弹簧圈栓塞。所有患者手术均1次成功。与介入治疗术前比较,介入治疗术后3天肌酐出现升高,差异有统计学意义(P<0.05),与介入治疗术后3天比较,介入治疗术后1个月、3个月肌酐降低,差异有统计学意义(P<0.05)。与介入治疗术前比较,术后3天、1个月、3个月血红蛋白升高,差异有统计学意义(P<0.05)。随访3个月,患者出血停止,无肾功能不全、肾脓肿等并发症发生。结论个体化栓塞方案治疗多种原因导致的损伤性出血安全有效。Objective To explore the clinical application of individualized superselective renal artery embolization in the treatment of renal injury hemorrhage.Methods The data of 36 patients with renal injury hemorrhage were analyzed.According to different bleeding types,clinical manifestations and angiographic manifestations,different embolization timings and different embolic agent combinations were used.Then,we investigated investigate the individual embolic method and observed the effect.Results There were 32 simple pseudoaneurysms in 31 patients,there were 2 cases of PVA granule embolism,1 case of medical glue embolism,1 case of medical glue combined with micro spring coil,27 cases of micro spring coil combined with gelatin sponge granule embolism,2 cases of pseudoaneurysm with renal arteriovenous fistula.We embolized with microcoil combined with gelatin sponge particles.Pseudoaneurysm with contrast medium extravasation was found in 3 cases,embolized with gelatin sponge particles or combined with microcoils.All patients were operated successfully once.Compared with that before intervention,creatinine increased 3 days after intervention,with a statistically significant difference(P<0.05),compared with 3 days after the intervention,creatinine decreased 1 month and 3 months after the intervention,with a statistically significant difference(P<0.05).Compared with that before intervention,the hemoglobin increased 3 days after operation,1 month after operation,and 3 months after operation,with astatistically significant difference(P<0.05).During a 3-month follow-up,the patient's bleeding stopped,and there was no renal insufficiency or renal abscess.Conclusion Individualized embolization regimens are safe and effective in the treatment of renal injury and hemorrhage caused by multiple causes.

关 键 词：肾脏出血 栓塞治疗 介入性 放射学 

分 类 号：R692.1[医药卫生—泌尿科学] R815[医药卫生—外科学]