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

DSA manifestations and interventional treatment of renal artery with severe hemorrhage following PCNL

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 investigate the digital subtraction angiography (DSA) manifestations and clinical value of interventional embolization of renal artery with severe hemorrhage following percutaneous nephrolithotomy (PCNL).?Methods?34 patients with severe hemorrhage following PCNL from Feb 2012 to Jun 2015 were subjected to perform renal arterial DSA, which was followed by super-selective renal arterial embolization (SRAE) with steel micro-coils and guglielmi detachable coils together with or without biological glue (GLUBRAN2). The patients were followed up for 6 ~ 12 months.?Results?Of the 34 patients, DSA examination showed that renal artery pseudoaneurysm (RAP) was found in 22 (64.7%), renal arteriovenous fistula (RAVF) in 8 (23.5%) and RAP associated with RAVF in 4 (11.8%). Successful embolization with single session was achieved in all 34 patients. Both the technical success rate and the hemostasis rate were 100.0%. Meanwhile, the renal tissue and function were mainly reserved and no serious complication of embolization was observed. No hematuria recurrence or renal function failure appeared in all patients during the follow-up period. In 26 patients, different degree of embolism syndrome was observed after the treatment.?Conclusions?Renal artery pseudoaneurysm and renal arteriovenous fistula are the main types of renal artery injury resulting in severe hemorrhage after percutaneous nephrolithotomy. Super-selective renal arterial embolization (SRAE) with steel micro-coils and guglielmi detachable coils together with or without biological glue (GLUBRAN2) is a minimally invasive method that can promptly stop the renal bleeding, and preserve the renal tissue and function to the greatest possible advantage. Therefore, this technique should be regarded as the first choice in the treatment of the patients who suffered from severe hemorrhage occurred after PCNL.