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目的探讨超选择性肾动脉明胶海绵栓塞治疗肾脏损伤出血的临床价值。方法收集2006年3月至2010年3月进行超选择性肾动脉栓塞的18例肾脏损伤出血患者的临床资料进行回顾性分析。手术步骤:首先在DSA观察下进行肾动脉造影寻找出血的血管,接着用明胶海绵颗粒或辅以弹簧圈进行超选择性肾动脉栓塞。观察止血效果及近远期副作用。所有患者随访4个月至3年,平均12.9个月。结果肾动脉造影结果显示,肾损伤所致出血的肾动脉分支包括:前支(3例),后支(7例),前支及后支(1例),肾段动脉(5例),段以下动脉(2例);合并包膜下或肾周血肿11例,动静脉瘘2例,假性动脉瘤5例。18例患者均成功地进行了超选择性肾动脉栓塞术。术后临床症状缓解,1～2h内血压稳定,4～48h肉眼血尿消失,6～12d尿常规隐血试验转阴,无肾出血复发;术后1周血尿素氮、肌酐及血压正常,B超或CT检查患侧肾脏呈部分栓塞表现。随访发现肾功能不全2例,B超检查见患侧肾脏缩小,未见再出血,无肾血管性高血压发生。不良反应主要为腰背酸胀疼痛、发热等栓塞后综合征表现,对症治疗3～14d缓解。无异位栓塞及其他严重并发症。结论使用明胶海绵超选择性肾动脉栓塞是治疗肾脏损伤出血安全有效的方法,具有创伤小、疗效好、并发症少、能保护患侧肾功能的优点。
Objective To investigate the clinical value of superselective renal artery gelatin sponge embolization in the treatment of renal injury hemorrhage. Methods The clinical data of 18 patients with renal damage hemorrhage who were treated by superselective renal artery embolization from March 2006 to March 2010 were retrospectively analyzed. Surgical Procedures: First, renal artery angiography is performed to look for bleeding blood vessels under DSA observation. Superselective renal artery embolization is performed with gelatin sponge particles or with coils. Observe the hemostatic effect and short-term side effects. All patients were followed up for 4 months to 3 years, an average of 12.9 months. Results Renal artery angiography showed that the branches of the renal arteries that caused by renal injury include anterior branch (3 cases), posterior branch (7 cases), anterior branch and posterior branch (1 case), renal artery (5 cases) Sections of the following arteries (2 cases); with subencapsular or peritoneal hematoma in 11 cases, arteriovenous fistula in 2 cases, 5 cases of pseudoaneurysm. All 18 patients underwent superselective renal artery embolization. Postoperative clinical symptoms, stable blood pressure within 1 ~ 2h, 4 ~ 48h gross hematuria disappeared, 6 ~ 12d urine routine occult blood test was negative, no recurrence of renal bleeding; 1 week after surgery, blood urea nitrogen, creatinine and blood pressure, B- Or CT examination of ipsilateral kidney showed partial embolism. Follow-up found 2 cases of renal insufficiency, B-ultrasound to see ipsilateral kidneys shrink, no further bleeding, no renal vascular hypertension occurred. Adverse reactions mainly sore back pain, fever and other signs of embolism syndrome, symptomatic treatment of 3 ~ 14d ease. Ectopic embolization and other serious complications. Conclusion The use of gelatin sponge super selective renal artery embolization is a safe and effective method for the treatment of renal damage and bleeding. It has the advantages of small trauma, good curative effect, less complications and protection of ipsilateral renal function.