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目的探讨研究超选择性的肾动脉栓塞治疗经皮肾镜取石术后肾出血的临床疗效。方法收集曲靖市第一人民医院2008年6月至2012年6月经皮肾镜取石术后肾出血患者15例,其中单发结石5例,多发结石10例;位于肾下盏7例,中盏6例,上盏2例。所有患者术前行多层螺旋CT血管造影检查显示单纯肾段以下小动脉损伤6例,伴有假性动脉瘤7例,合并动静脉瘘3例;2例未显示出血灶。于出血后10 h～2周行肾动脉造影后,用明胶海绵和弹簧圈超选择性肾动脉栓塞止血。结果 15例患者成功进行了超选择性肾动脉栓塞治疗,其中6例单纯肾段以下小动脉损伤,用明胶海绵一次栓塞成功,伴有假性动脉瘤和合并动静脉瘘者用明胶海绵和弹簧圈联合栓塞,2例未显示出血灶患者用明胶海绵预防性栓塞;15例肾出血患者一次性栓塞止血成功14例,成功率为93.3%,1例行二次栓塞止血成功。结论超选择性肾动脉栓塞治疗经皮肾镜取石术后肾出血成功率高,创伤小,值得临床推广。
Objective To study the clinical effect of percutaneous nephrolithotomy on renal hemorrhage in patients undergoing selective renal artery embolization. Methods Fifteen patients with renal hemorrhage after percutaneous nephrolithotomy were collected from Qujing First People’s Hospital from June 2008 to June 2012. Among them, 5 were single solitary stones and 10 were multiple stones. Among the 7 cases, 6 cases, upper case 2 cases. All patients underwent preoperative multi-slice spiral CT angiography showed simple renal artery injury in 6 cases, with pseudoaneurysm in 7 cases, merger arteriovenous fistula in 3 cases; 2 cases showed no focal. After hemorrhage 10 h ~ 2 weeks after renal artery angiography, gelatin sponge and coil super selective renal artery embolization to stop bleeding. Results Fifteen patients were successfully treated with superselective renal artery embolization. Among them, 6 cases of small arteries with simple renal artery injury were successfully embolized with gelatin sponge. The patients with pseudoaneurysm and arteriovenous fistula were treated with gelatin sponge and spring Circle combined embolization, 2 cases of patients without hemorrhage with gelatin sponge prophylactic embolism; 15 cases of renal hemorrhage in patients with a single embolization hemostasis was successful in 14 cases, the success rate was 93.3%, 1 case of second embolization to stop bleeding success. Conclusion Superselective renal artery embolization for percutaneous nephrolithotomy has a high success rate of renal hemorrhage and less trauma, which is worthy of clinical promotion.