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目的探讨医源性肾动脉损伤的肾动脉造影表现及栓塞治疗效果。方法收集2005年8月至2008年11月间我院于肾脏手术后出现持续性或间断性肉眼血尿患者共14例。均经肾动脉造影证实为医源性肾动脉损伤,其中继发于经皮肾镜取石术11例,继发于肾穿刺活检术、肾贯穿伤缝合修补术、输尿管镜检查并双J管置放术各1例。血尿出现距手术操作时间为3～346d(中位时间8d)。肾动脉造影检查后均行经导管肾动脉节段性栓塞治疗。栓塞材料为弹簧圈、正丁基-2-氰基丙烯酸酯(NBCA)、聚乙烯醇(PVA)颗粒、无水乙醇。术后随访10～49个月。结果病变位于肾脏上极4例,下极10例。肾动脉造影表现为肾假性动脉瘤1例,肾动静脉瘘6例,肾假性动脉瘤合并动静脉瘘7例。栓塞后肾动脉造影显示病变均达到完全性栓塞,术后2～12d肉眼血尿消失。随访期间,1例右肾下极动静脉瘘栓塞后13个月因术侧肾区钝性外伤再次出现血尿,经造影证实原动静脉瘘未见复发,但右肾下极发现由另一叶间动脉供血形成的假性动脉瘤,再次使用弹簧圈栓塞,随访14个月未见血尿复发。其余13例随访10～49个月未见血尿复发。本组术后均无严重并发症。结论肾动静脉瘘、假性动脉瘤是医源性肾动脉损伤的主要类型,应用弹簧圈行肾动脉节段性栓塞治疗是一种安全、有效的治疗方法。
Objective To investigate the renal artery angiography of iatrogenic renal artery injury and the effect of embolization. Methods A total of 14 patients with persistent or intermittent gross hematuria after renal surgery were collected from August 2005 to November 2008 in our hospital. Renal artery angiography were confirmed by renal artery angiography, of which 11 cases were secondary to percutaneous nephrolithotomy, secondary to renal biopsy, renal interstitial suture repair, ureteroscopy and double J tube set Radiotherapy in 1 case. Hematuria appeared from the operation time of 3 ~ 346d (median time 8d). Renal artery angiography were performed by segmental embolization of the renal artery. Embolization material for the coil, n-butyl-2-cyanoacrylate (NBCA), polyvinyl alcohol (PVA) particles, ethanol. The patients were followed up for 10 to 49 months. Results The lesions were located in the upper pole of the kidney in 4 cases and in the lower pole in 10 cases. Renal angiography showed renal pseudoaneurysm in 1 case, 6 cases of renal arteriovenous fistula, 7 cases of renal pseudoaneurysm with arteriovenous fistula. Embolization of renal artery angiography showed complete embolization of lesions, 2 to 12 days after gross hematuria disappeared. During the follow-up period, hematuria again occurred in 13 cases of blunt right arteriovenous fistula after thromboembolism due to blunt trauma in the contralateral kidney. The angiography confirmed no recurrence of the original arteriovenous fistula, Pseudoaneurysm formed by inter-arterial blood supply, again using coil embolization, no follow-up 14 months hematuria recurrence. The remaining 13 cases were followed up for 10 to 49 months without hematuria recurrence. This group were no serious complications after surgery. Conclusions Renal arteriovenous fistula and pseudoaneurysm are the main types of iatrogenic renal artery injury. It is a safe and effective method to treat segmental renal artery embolism with coil.