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中华介入放射学电子杂志 ›› 2014, Vol. 02 ›› Issue (04) : 18 -21. doi: 10.3877/cma.j.issn.2095-5782.2014.04.006

所属专题: 文献

血管介入

医源性肾血管损伤出血的介入治疗
宋鹏1, 段峰2, 王燕2, 刘凤永2, 王茂强2,()   
  1. 1. 100853 中国人民解放军总医院介入放射科;300071 天津,南开大学医学院
    2. 100853 中国人民解放军总医院介入放射科
  • 收稿日期:2014-03-04 出版日期:2014-11-01
  • 通信作者: 王茂强

Transarterial embolization in treatment of iatrogenic renal hemorrhage

Peng Song1, Feng Duan2, Yan Wang2, Fengyong Liu2, Maoqiang Wang2,()   

  1. 1. Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2014-03-04 Published:2014-11-01
  • Corresponding author: Maoqiang Wang
  • About author:
    Corresponding author: WANG Mao-qiang, E-mail:
引用本文:

宋鹏, 段峰, 王燕, 刘凤永, 王茂强. 医源性肾血管损伤出血的介入治疗[J/OL]. 中华介入放射学电子杂志, 2014, 02(04): 18-21.

Peng Song, Feng Duan, Yan Wang, Fengyong Liu, Maoqiang Wang. Transarterial embolization in treatment of iatrogenic renal hemorrhage[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2014, 02(04): 18-21.

目的

评价应用血管内栓塞技术治疗医源性肾血管损伤出血的安全性和疗效。

方法

对34例医源性肾血管损伤出血患者进行了超选择性肾动脉栓塞治疗。损伤原因有肾脏穿刺活检术后14例,肾部分切除术后8例,经皮肾镜碎石术后8例,经皮肾盂造瘘术后3例,经皮氩氦刀术后1例。栓塞材料包括微钢丝圈、氰基丙烯酸正丁酯碘油混合物、聚乙烯醇微球、明胶海绵碎粒。

结果

选择性肾动脉造影显示肾实质假性动脉瘤21例,肾动静脉瘘8例,肾实质破裂造影剂外溢10例。栓塞技术成功率为100%,治疗结束时复查造影显示异常血管消失,正常分支保留。30例患者栓塞后失血症状改善,栓塞后30天内出院,4例患者术前伴失血性休克,栓塞后10天内死亡。30例患者随访5~48个月均未再出血,也未出现其他严重并发症,16例死于原发疾病。

结论

经导管选择性肾动脉分支栓塞术是治疗医源性肾血管损伤出血安全有效的方法。

Objective

To evaluate the safety and efficacy of interventional techniques for emergent treatment of iatrogenic renal vascular injuries.

Methods

Thirty-four patients with iatrogenic renal vascular injuries were treated with transarterial embolization (TAE). A total of 14 had history of renal biopsy, 8 had partial nephrectomy, 8 had percutaneous nephrolithotomy (PCNL), 3 had percutaneous nephrostomy (PNT), and 1 had percutaneous argon-helium knife. The embolic materials include metallic coils, N-butyl cyanoacrylate (NBCA) iodized oil mixture, polyvinyl alcohol particles (PVA) and gelfoam were used.

Results

Renal angiogram revealed the pseudoaneurysm in 21 cases, the arteriovenous fistula in 8 cases, and contrast media extravasation in 10 cases. The successful rate of technical was 100%. Medical successes were achieved in 30 patients, and discharged in 30 days later after the embolizations. Four patients died in 10 days later after the embolizations, and all of them accompanied with hemorrhagic shock. Follow-up time ranged from 5—48 months, all of the 30 patients have no re-bleeding and other serious complications, but 16 patients died of primary disease.

Conclusions

TAE is a safe and effective treatment method for iatrogenic renal vascular injuries.

图1 患者男,55岁A.经皮肾镜碎石术后持续血尿,超选择肾动脉分支造影显示一假性动脉瘤形成(箭);B.用NBCA胶行超选择性栓塞术后复查造影显示,假性动脉瘤腔由NBCA(箭)完全充填,正常肾动脉分支保留
图2 患者男,52岁A.肾部分切除术后持续血尿,肾动脉造影显示肾下极假性动脉瘤(短箭)、动静脉瘘形成,动脉期可见肾静脉分支(长箭)及主干(粗箭)显影。B.用钢丝圈行超选择性肾动脉分支栓塞后造影显示假性动脉瘤及动静脉瘘消失(箭)
图3 患者男,49岁A.经皮肾镜碎石术后血尿伴肾周血肿形成,肾动脉造影显示造影剂外溢(箭)。B.用钢丝圈行超选择性肾动脉分支栓塞术后,复查造影栓塞部位无对比剂外溢(箭),正常分支保留。C.栓塞后2天行肾周血肿穿刺引流,再发出血,超选择血管造影显示左肾上极对比剂外溢(箭。D.用NBCA行第二次栓塞,后出血停止(箭),正常分支被保留
1
Somani BK, Nabi G, Thorpe P, et al. Endovascular control of haemorrhagic urological emergencies: an observational study[J]. BMC Urol, 2006,6: 27.
2
Mavili E, Dönmez H, Ozcan N, et al. Transarterial embolization for renal arterial bleeding[J]. Diagn Interv Radiol, 2009,15(2): 143–147
3
Poulakis V, Ferakis N, Becht E, et al. Treatment of renal-vascular injury by transcatheter embolization: immediate and long-term effects on renal function[J]. J Endourol, 2006,20(4): 405-409.
4
Breyer BN, McAninch JW, Elliott SP,et al. Minimally invasive endovascular techniques to treat acute renal hemorrhage[J]. J Urol, 2008,179(6): 2248-2252.
5
Fischer RG, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization[J]. AJR Am J Roentgenol, 1989,152(6): 1231-1235.
6
Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery[J]. J Urol 1995,153: 604-608.
7
Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound guided renal biopsy[J]. Kidney Int, 2004,66(4): 1570-1577.
8
Dinkel HP, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients[J]. Radiology, 2002,223(3): 723-730.
9
Brandes SB, McAninch JW. Urban free falls and patterns of renal injury: a 20-year experience with 396 cases[J]. J Trauma, 1999,47(4): 643-649.
10
Maleux G, Messiaen T, Stockx L, et al. Transcatheter embolization of biopsy- related vascular injuries in renal allografts. Long term technical, clinical and biochemical results[J]. Acta Radiologica, 2003,44(1): 13-17.
11
Ginat DT, Saad WE, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques[J]. Tech Vasc Interv Radiol, 2009,12(4): 224-239.
12
Cimsit NC, Baltacioglu F, Cengic I, et al. Transarterial glue embolization in iatrogenic renovascular injuries[J]. Int Urol Nephrol, 2008,40(4): 875-879.
13
Kim J, Shin JH, Yoon HK, et al. Transcatheter renal artery embolization with N-butyl cyanoacrylate[J]. Acta Radiol, 2012,53(4): 415-421.
14
Cantasdemir M, Adaletli I, Cebi D, et al. Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate[J]. Clin Radiol, 2003,58(7): 560-565.
15
王仲朴,王茂强,孙永光,等.含钆造影剂在动脉血管造影和介入治疗中的初步应用[J].介入放射学杂志,2002,11(2): 97-101.
16
王茂强,李生,谢春明,等.创伤性肾动静脉瘘的介入治疗[J].中华创伤杂志,2004,20(5): 273-276.
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