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目的探讨超选择性肾动脉栓塞治疗微创经皮肾镜取石术后继发出血的临床价值。方法回顾和分析我院2003年2月￣2007年5月应用微创经皮肾镜取石术(MPCNL)治疗上尿路结石1311例术后并发出血行超选择性肾动脉栓塞治疗5例的资料。结果5例中4例一次性治愈,1例3d后再次行栓塞治疗后治愈。5例患者栓塞后出血立即得到控制。出血原因:1例肾动脉损伤,3例假性动脉瘤,1例动静脉瘘。术后无一例发生栓塞后综合症、异位栓塞现象及其他介入治疗并发症。5例术后1个月复查肾图、IVU和B超声,患肾功能均有不同程度改善,术后无明显肾功能损害。结论超选择性肾动脉栓塞是MPCNL术后出血治疗的首选方法,安全性高,疗效好。
Objective To investigate the clinical value of superselective renal artery embolization in the treatment of secondary hemorrhage after minimally invasive percutaneous nephrolithotomy. Methods From January 2003 to May 2007, we retrospectively analyzed and analyzed the data of 1311 cases of upper urinary calculi treated with minimally invasive percutaneous nephrolithotomy (MPCNL) in our hospital from February 2003 to May 2007 and the data of 5 cases treated by ultrasonographic renal artery embolization . Results 4 of 5 cases were cured at one time, and one case of 3d was cured again after embolization. Five patients had immediate control of bleeding after embolization. Causes of bleeding: 1 case of renal artery injury, 3 cases of pseudoaneurysm, 1 case of arteriovenous fistula. No case of postoperative embolism syndrome, ectopic embolism and other interventional complications. Renal examination was performed in 5 cases one month after operation. IVU and B ultrasound were used to improve renal function in varying degrees. There was no obvious renal dysfunction after operation. Conclusions Superselective renal artery embolization is the first choice for the treatment of postoperative bleeding after MPCNL. It has high safety and good curative effect.