经皮肾镜取石术后肾出血的DSA表现及介入治疗  

DSA findings and interventional therapy of renal hemorrhage after PCNL

作　　者：张国栋 林宇佳 曾国斌[1] 廖政贤[1] 张文 ZHANG Guodong;LIN Yujia;ZENG Guobin;LIAO Zhengxian;ZHANG Wen(Interventional Surgery Center,Meizhou People's Hospital,Meizhou,Guangdong 514031,China)

机构地区：[1]梅州市人民医院介入手术中心,广东梅州514031

出　　处：《医药前沿》2023年第26期20-23,共4页Journal of Frontiers of Medicine

摘　　要：目的:探讨经皮肾镜取石术(PCNL)后肾出血的数字减影血管造影(DSA)表现及介入治疗。方法:分析2017年1月—2022年12月65例行PCNL后肾出血的患者,行腹主动脉造影及选择性或超选择性左右肾动脉及其分支造影,明确病变血管后用微导管插管至出血分支近端用吸收性明胶海绵、氰基丙烯酸正丁酯(NBCA)胶、金属弹簧钢圈等进行栓塞;分析其造影表现及栓塞效果。结果:65例患者中63例造影阳性,其中单纯假性动脉瘤21例,假性动脉瘤伴动-静脉瘘16例,单纯造影剂外溢15例,造影剂外溢伴动-静脉瘘6例,单纯动-静脉瘘4例,1例肾动脉分支呈“残根征”,2例阴性;所有阳性患者均成功插管进行介入栓塞,栓塞术后行肾动脉造影均未见出血病灶,止血率为100%,另外2例阴性患者留置导管泵注垂体后叶素.结论:选择性或超选择性血管造影对PCNL后肾出血诊断明确,定位准确,而介入治疗是PCNL后肾出血患者安全、有效、创伤小的止血治疗方法。Objective To study the digital subtraction angiography(DSA)manifestations of renal hemorrhage after percutaneous nephrolithotomy(PCNL)and the clinical application of interventional therapy.Methods A retrospective analysis was conducted on 65 patients with renal hemorrhage after PCNL from January 2017 to December 2022 who underwent abdominal aortic angiography and selective or superselective left and right renal artery and its branches angiography.After identifying the diseased vessels,microcatheters were inserted to the proximal end of the bleeding branch and embolization was performed with gelatin sponge,n-butyl cyanoacrylate(NBCA)glue,metal spring steel coil,etc;Analyze the imaging manifestations and embolization effects.Results Among the 65 patients,63 cases showed positive angiography,including 21 cases of simple pseudoaneurysm,16 cases of pseudoaneurysm with arteriovenous fistula,15 cases of simple contrast agent overflow,6 cases of contrast agent overflow with arteriovenous fistula,4 cases of simple arteriovenous fistula,1 case of renal artery branch showing“residual sign”,and 2 cases showing negative;All positive patients were successfully intubated for interventional embolization.After embolization,renal artery angiography showed no bleeding lesions,and the hemostasis rate was 100%.In addition,one negative patient was indwelling a catheter to pump pituitrin.Conclusions Selective or superselective angiography has a clear diagnosis and accurate localization of renal hemorrhage after PCNL,and interventional therapy is a safe,effective,and minimally invasive hemostatic treatment method for patients with renal hemorrhage after PCNL.

关 键 词：肾出血 介入治疗 介入栓塞 经皮肾镜取石术 

分 类 号：R692[医药卫生—泌尿科学]