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目的探讨超选择性动脉栓塞在医源性损伤导致的肾岀血中的应用价值。方法 2009年12月至2012年2月收治11例医源性损伤导致的肾岀血患者,其中肾造瘘术后出血3例,经皮肾镜取石术术后岀血3例,肾肿瘤部分性肾切除术后岀血3例,钬激光术后2例。采用超选择方法将导管置于岀血动脉,用聚乙烯醇颗粒及弹簧圈或(和)微弹簧圈栓塞治疗。结果所有患者均一次性成功进行岀血动脉栓塞治疗,造影过程中可见动静脉瘘,对比剂外溢、滞留及假性动脉瘤形成。所有患者在栓塞治疗后岀血症状均消失,未观察到明显的肾功能损害,临床随访4～35个月未再发生岀血。结论超选择性动脉栓塞是治疗医源性肾岀血的有效、安全的方法,值得在临床推广应用。
Objective To investigate the value of super selective arterial embolization in the treatment of iatrogenic injury caused by iatrogenic injury. Methods From December 2009 to February 2012, 11 cases of idiopathic renal hemorrhage caused by iatrogenic injury were treated. Among them, 3 cases were postoperative nephrostomy, 3 cases were percutaneous nephrolithotomy, 3 cases were renal tumor, 3 cases of hemorrhage after nephrectomy, 2 cases after holmium laser. The catheter was placed in a popliteal artery using an ultra-selective method with polyvinyl alcohol particles and a coil or (and) a coil spring embolization. Results All patients were successfully treated with hemoarterial embolization in one operation. Arteriovenous fistula, contrast agent spillover, retention and pseudoaneurysm formation were observed during the angiography. All patients had no symptoms of hematochezia disappeared after embolization, and no obvious renal dysfunction was observed. No blood stasis occurred in 4 ~ 35 months of clinical follow-up. Conclusion Superselective arterial embolization is an effective and safe method for the treatment of iatrogenic nephrotic syndrome and is worthy of clinical application.