医源性肾血管损伤的急诊血管内栓塞治疗.pdfVIP

墼壁堂壅查 !生! 笙! 鲞箩— J Intervent Radiol 2007，Vo1．16，No．12 ——807一 · 血管介入 Vascular intervention· 医源性肾血管损伤的急诊血管内栓塞治疗 刘凤永， 王茂强， 段 峰， 王志军， 王仲仆 【摘要】 目的 评价用介入技术治疗医源性肾血管损伤的安全性和疗效。方法 对9例医源性肾血 管损伤患者进行了超选择性肾动脉栓塞治疗。损伤原因有行肾脏穿刺活检术后5例、血管内介入治疗术 后2例、经皮穿刺右肾盂造瘘术后 1例、肾脏肿瘤局部切除术后1例。临床表现有失血性休克7例、患侧剧 烈腰痛7例、血尿8例；CT和超声波检查发现肾脏周围血肿8例。栓塞材料用微型钢丝圈7例、普通钢丝 圈2例，同时用聚乙烯醇微球5例、用明胶海绵碎粒2例。结果 选择性肾动脉造影显示肾实质内动静脉 瘘6例、假性动脉瘤2例、肾实质血管破裂对比剂外溢1例。本组9例均栓塞成功；治疗结束时复查造影显 示异常血管消失，正常分支保留。7例失血症状明显者，栓塞后经给予补充血容量、失血症状迅速改善；7 例剧烈腰痛者，术后2～4 d腰痛消失；血尿8例，术后2～14 d消失。术后原有肾功能不全加重3例、新 出现肾功能不全2例，其中2例接受血液透析治疗。超声复查显示肾周围血肿于2～4个月逐渐吸收。随 访6～78个月(平均38个月)，4例死于原发疾病，5例健在、未再针对肾脏损伤进行外科或介入治疗。未 再发生出血，血肌酐、尿素测定属正常范围。结论 经导管选择性肾动脉分支栓塞术是治疗医源性肾脏血 管损伤的安全、有效方法。 【关键词】 肾脏，损伤；肾动脉造影术；肾动脉，治疗性栓塞；介入治疗，并发症 中图分类号：R692．16 文献标识码：A 文章编号：1008．794X(2007)．12—0807—04 Emergent endovascular embolization of iatrogenic renal vascular injuries LIU Feng-yong，WA NG Mao— g ，DUAN Feng，WANG Zhi-jun，WANG Z~ng-pm Department of lnterventional Radiology，General Hospital ofPLA．Beoing loo853．China 【Abstract】 Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenie renal injuries．Methods Nine patients with iatrogenic renal vascular injuries were treated t}l superselective renal arterial embolization．The causes of renal injury included post—renal biopsy in 5 patients，endovascular interventional procedure—related in 2，post—renal surgery in 1，and post—percutaneous nephrostomy in 1 patient．The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patients，severe flank pain in 7，and hematuria in 8 patients．Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography． The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients，associated with polyvinyl alcohol particles(PVA)in 5，and gelfoam partic