摘要
【目的】探讨超选择肾动脉栓塞术在治疗经皮肾镜碎石术（PCNL）术后严重出血的疗效。【方法】2004年4月至2008年6月，采用PCNL治疗上尿路结石358例患者共经历427次经皮肾镜取石，6例患者出现术后严重出血，行肾动脉血管造影及栓塞术。平均年龄42．6（27～68）岁，平均开始出血时间为术后3（1～13）d。均接受输血补液等保守治疗，不能维持生命体征，选择性血管造影检查，明胶海绵颗粒、微钢圈动脉栓塞治疗。【结果】肾脏血管造影提示活动性动脉出血。6例患者接受血管超选择栓塞术，栓塞方法采用金属圈和凝胶海绵栓塞，术后出血立即停止。5例患者随访平均17个月，患肾肾功能正常，无并发症发生。【结论】PCNL术后严重出血及时通过肾动脉造影可确诊，超选择性肾段动脉栓塞止血可靠，疗效确切。
[Objective] To explore the role of superselective renal artery embolization in the management of severe hemorrhage after percutaneous nephrolithotomy （PCNL）. [Methods] The data of 358 patients who un- derwent a total of 427 percutaneous nephrolithotomy procedures at our center from April 2004 to June 2008 were analyzed retrospectively. Six patients had developed severe hemorrhage and accepted blood transfusion, supplement of crystalloid and colloidal solution, but presented with clinical signs of haemodynamic instability. Mean age was 42.6 years （range 27 to 68） and the mean time to the onset of severe hemorrhage was 3 days （range 1 to 13）. All patients underwent angiography and subsequent transcatheter arterial embolization （TAE） with micro-coil and gelatin sponge particles. [Results] Renal arteriography revealed sign of active bleeding in all 6 cases. Bleeding was effectively controlled with superselective renal artery embolization of the lesion by the metallic coils and Gelfoam. Follow up was available on 5 patients （mean 17 months）. The renal function was stable in all patients. No complications occurred. [Conclusion] Arterial injury and severe hemor- rhage after percutaneous nephrolithotomy are usually diagnosed by renal angiography. Superselective segmen- tal renal artery catheterization and embolization is a safe and effective method for this complication.
出处
《医学临床研究》
CAS
2009年第9期1653-1654,共2页
Journal of Clinical Research
关键词
碎石术
手术后并发症
出A/治疗
肾动脉
栓塞
治疗性
lithotripsy
postoperative complications
hemorrhage/TH
renal artery
emboliza- tion, therapeutic
