经皮肾镜取石术后大出血肾动脉数字减影血管造影表现及介入治疗

发布时间：2018-08-06 11:24

【摘要】：目的探讨经皮肾镜取石术(PCNL)后大出血肾动脉数字减影血管造影(DSA)表现及介入栓塞治疗的价值。方法收集2012年1月-2015年6月PCNL术后大出血患者34例,均经肾动脉DSA检查,并采取超选择性肾动脉栓塞(SRAE)治疗,栓塞材料为微弹簧毛圈、电解脱弹簧圈和/或生物胶(GLUBRAN2)。术后随访6个月~1年。结果 34例患者中DSA表现为肾动脉分支假性动脉瘤(RAP)22例(64.7%),肾动静脉瘘(RAVF)8例(23.5%),RAP伴RAVF 4例(11.8%)。所有患者均一次栓塞成功,技术成功率及止血率100.0%,最大程度保留病肾组织及功能,无严重并发症发生,术后随访6个月~1年,全部病例无血尿复发,肾功能正常。26例患者术后出现不同程度的栓塞综合征。结论 RAP、RAVF是PCNL术后肾动脉损伤导致大出血的主要类型;采用微弹簧毛圈、电解脱弹簧圈和/或GLUBRAN2胶行SRAE创伤小、止血迅速彻底,能最大限度保留肾组织及功能,是PCNL术后大出血的首选治疗方法。
[Abstract]:Objective to evaluate the value of digital subtraction angiography (DSA) and interventional embolization in massive hemorrhage after percutaneous nephrolithotomy (PCNL). Methods 34 patients with massive hemorrhage after PCNL from January 2012 to June 2015 were examined by renal artery DSA and treated with superselective renal artery embolization (SRAE). The embolization materials were microcoils, electric detachable coils and / or biogel (GLUBRAN2). All patients were followed up for 6 months to 1 year. Results among the 34 patients, 22 cases (64.7%) showed renal artery branching pseudoaneurysm (RAP), 8 cases (23.5%) with renal arteriovenous fistula (RAVF) and 4 cases (11.8%) with renal arteriovenous fistula with RAVF. All the patients were successfully embolized at one time, the technical success rate and hemostatic rate were 100.0%, the renal tissue and function of the disease were preserved to the maximum extent, and no serious complications occurred. All the patients were followed up for 6 months to 1 year after operation. No recurrence of hematuria was found in all cases. Renal function was normal in 26 patients with different degree of embolism syndrome. Conclusion Rapa RAVF is the main type of massive hemorrhage caused by renal artery injury after PCNL, and the use of microcoils, electric detachable coils and / or GLUBRAN2 glue for SRAE has little trauma, rapid and thorough hemostasis, and can preserve renal tissue and function to the maximum extent. It is the first choice of treatment for massive hemorrhage after PCNL.
【作者单位】：湖南省常德市职业技术学院附属第一医院放射科;
【分类号】：R699.2

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