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目的探讨经皮肾镜取石术(PCNL)后肉眼血尿的临床分型与肾动脉造影表现的相关性和超选择性肾动脉栓塞的治疗时机。方法回顾性分析78例PCNL后肉眼血尿患者的临床表现和造影征象,其中76例行超选择性肾动脉栓塞治疗。结果根据肾出血的临床表现分为Ⅲ型:急性持续性出血(Ⅰ型)17例,间歇性活动性出血(Ⅱ型)50例,缓慢持续性出血(Ⅲ型)11例。肾动脉造影表现:假性动脉瘤37例,假性动脉瘤并动静脉瘘14例,动静脉瘘10例,对比剂外溢8例,对比剂外溢并动静脉瘘4例,假性动脉瘤并肾盏瘘2例,首次造影阴性3例。成功栓塞76例,4例栓塞后再出血行第2次栓塞。2例造影阴性者经导管注入血凝酶1IU后保守治疗出血停止。结论超选择性肾动脉栓塞是PCNL后出血的最好治疗方法,对于Ⅰ、Ⅱ型出血,应尽快行超选择性肾动脉栓塞治疗,而对于Ⅲ型出血,若保守治疗出血控制不理想时,也应该行肾动脉栓塞治疗。
Objective To investigate the correlation between the clinical classification of gross hematuria after percutaneous nephrolithotomy (PCNL) and the manifestations of renal artery angiography and the treatment timing of superselective renal artery embolism. Methods Retrospective analysis of 78 cases of PCNL after gross hematuria in patients with clinical manifestations and imaging signs, of which 76 cases of ultra-selective renal artery embolization. Results According to the clinical manifestations of renal bleeding were divided into type Ⅲ: 17 cases of acute persistent hemorrhage (Ⅰ type), intermittent active bleeding (Ⅱ type) 50 cases, 11 cases of slow persistent bleeding (Ⅲ). Renal angiography: pseudoaneurysm in 37 cases, pseudoaneurysm and arteriovenous fistula in 14 cases, arteriovenous fistula in 10 cases, contrast agent spilled in 8 cases, contrast agent spilled and arteriovenous fistula in 4 cases, and pseudoaneurysm 2 cases of renal fistula, the first negative angiography in 3 cases. Successful embolization of 76 cases, 4 cases of rebleeding after the second embolization. 2 patients with negative angiography after transcatheter injection of hemagglutinin 1IU conservative treatment of bleeding stopped. Conclusions Superselective renal artery embolization is the best treatment for post-PCNL hemorrhage. For type I and type II hemorrhage, ultra-selective renal artery embolization should be performed as soon as possible. For type III hemorrhage, if conservative treatment of bleeding control is not satisfactory, Renal artery embolization should also be done.