超选择性肾动脉栓塞治疗不同病因肾出血的疗效评估  

Evaluation of the efficacy of super selective renal artery embolization in the treatment of renal hemorrhage from different causes

作　　者：彭晓正 杨会军 吴森林 李伍好 李波 许国胜 贺克武 Peng Xiaozheng;Yang Huijun;Wu Senlin;Li Wuhao;Li Bo;Xu Guosheng;He Kewu(Department of Interventional Vascular Surgery,the Third Affiliated Hospital of Anhui Medical University/the First People's Hospital of Hefei,Hefei 230061,Anhui,China)

机构地区：[1]安徽医科大学第三附属医院/合肥市第一人民医院介入血管外科,安徽合肥230061

出　　处：《血管与腔内血管外科杂志》2024年第1期46-50,共5页Journal of Vascular and Endovascular Surgery

基　　金：安徽省重点研究与开发计划(2023s07020023)。

摘　　要：目的评估超选择性肾动脉栓塞治疗不同病因肾出血的疗效及安全性。方法收集2018年7月至2023年6月安徽医科大学第三附属医院/合肥市第一人民医院收治的18例不同病因导致肾出血患者的临床资料,所有患者均在内科保守治疗效果不佳或要求介入治疗后采用了超选择性肾动脉栓塞治疗。观察所有患者的术中造影表现、介入栓塞治疗效果及介入术后并发症发生情况。结果18例患者术中造影表现均为阳性,其中,11例患者表现为单纯造影剂聚集或外溢;2例患者表现为造影剂外溢合并动静脉畸形;1例患者表现为造影剂外溢合并假性动脉瘤;4例患者表现为靶血管增粗,分支杂乱,部分可见瘤样扩张。18例患者术后活动性出血停止,肉眼血尿逐渐好转至消失,肾周血肿逐渐吸收,术后血红蛋白水平高于术前(P﹤0.05),治疗有效率为100%。2例患者术后发生轻度栓塞后综合征。所有患者均未出现严重并发症。除了2例透析患者外,其余16例患者术后肾功能均正常。结论超选择性肾动脉栓塞治疗肾出血的疗效显著,创伤性小,对肾功能无明显损伤,安全性高,可作为内科保守治疗效果不佳的各种病因所致肾出血患者的首选治疗方法。Objective To evaluate the efficacy and safety of super selective renal artery embolization in the treatment of renal hemorrhage from different causes.Method The clinical data of 18 cases patients with renal hemorrhage due to different causes admitted to the Third Affiliated Hospital of Anhui Medical University/the First People's Hospital of Hefei from July 2018 to June 2023 were collected.All patients underwent super selective renal artery embolization treatment after poor conservative treatment efficacy in internal medicine or requiring interventional treatment.The intraoperative angiographic appearance,effect of interventional embolization treatment,and incidence of complications after interventional surgery in all patients were observed.Result All the 18 cases patients had positive intraoperative angiographic appearance,among which 11 cases patients showed the accumulation or extravasation of contrast media;2 cases patients showed the extravasation of contrast media with arteriovenous malformation;1 case patient showed extravasation of contrast media with pseudoaneurysm;4 cases patients showed enlargement of target vessels,disorganized branches and some tumor-like dilatation.Active bleeding was stopped and gross hematuria gradually improved,the perirenal hematoma was gradually absorbed in 18 cases patients.The hemoglobin level after operation was higher than that before surgery(P<0.05),the treatment effectiveness rate is 100%.Two cases patients had mild post-embolization syndrome.No severe complications occurred in all patients.After surgery,16 patients had renal insufficiency except for 2 dialysis patients.Conclusion Super selective renal artery embolization is an effective and safe method for the treatment of renal hemorrhage,with high safety and no significant damage to renal function,it can be the first choice for the treatment of renal hemorrhage from different causes after poor conservative treatment efficacy in internal medicine.

关 键 词：肾动脉栓塞 超选择 肾出血 疗效 介入治疗 

分 类 号：R543[医药卫生—心血管疾病]