超选择肾动脉栓塞术在经皮肾镜取石术后肾出血治疗中的应用

摘要

目的:探讨超选择性肾动脉栓塞术(SRAE)在经皮肾镜取石术(PCNL)后肾出血中的应用效果.方法:选择因肾结石性经PCNL术后肾出血患者34例,采取超选择肾动脉栓塞术进行治疗,分析肾动脉造影及栓塞情况,观察SRAE前后患者血常规、肾功能指标的变化.结果:34例患者1次栓塞成功率为94.12%.术后第1天,34例患者血细胞比容及血红蛋白水平较术前明显下降(P<0.05或P<0.01),术后第3天均明显升高(P<0.05),接近于术前水平;术前及术后第1、7天血肌酐水平比较差异无统计学意义(P>0.05).结论:SRAE治疗PCNL术后肾出血安全、有效,能在一定程度上保护患肾功能,但栓塞时导管栓塞技术的熟练掌握、造影图像的全面分析、栓塞材料的合理选择均有助于获得确切的止血疗效.%Objective:To explore the application effect of superselective renal artery embolization (SRAE) in the treatment of renal hemorrhage due to percutaneous nephrolithotomy (PCNL) .Methods :The clinical data of 34 patients who received SARE for the renal hemorrhage due to PCNL were retrospectively analyzed so as to analyze the conditions of renal arteriography and embolism ,and observe the changes of hematologic and renal function indexes before and after SRAE .Results :The successful rate of first embolism was 94 .12% in this study . Hematocrit (HCT) and hemoglobin level decreased markedly on postoperative d1 than surgery before (P<0 .05 or P<0 .01) , but increased notably on postoperative d3 (P<0 .05) ,with level near to that before surgery .There was insignificant difference in serum creatinine level on postoperative d1 and 7 when compared with that before surgery (P>0 .05) . Conclusion :SRAE is safe and effective in the treatment of renal hemorrhage due to PCNL ,and can protect renal function to some extent .Meanwhile ,the proficient grasp of catheter embolism technique ,the complete analysis of angiographic images and the reasonable selection of embolism materials in embolization can help to obtain excellent hemostatic efficacy .