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目的探讨经皮肾镜取石术(PCNL)后肾脏出血行超选择性肾动脉栓塞(SRAE)治疗的时机选择。方法 2005年6月至2013年2月,对2 165例上尿路结石患者的2 384个肾脏行PCNL治疗,术后有16例(0.74%)出现严重出血而行SRAE治疗。本文对这16例患者的出血特点及行SRAE的时机进行回顾性分析。结果 16例患者中,行1次SRAE止血成功15例,但在SRAE前或后行单纯性肾动脉造影(RAA)各1例;行2次SRAE止血成功1例。所有患者行初次RAA/SRAE时血色素平均下降32.9g/L,平均输血250mL;再次行RAA/SRAE时血色素时平均下降3.2g/L,未输血。15例患者顺利康复出院,1例死亡。结论对PCNL术后严重出血患者应尽早行SRAE,而对初次RAA阴性或SRAE后再出血的患者则应酌情行SRAE。
Objective To investigate the timing of treatment of renal failure due to percutaneous nephrolithotomy (PCNL) in patients with renal hemorrhage undergoing super-selective renal artery embolization (SRAE). Methods From June 2005 to February 2013, 2 384 kidneys from 2 165 patients with upper urinary calculi underwent PCNL. Sixteen patients (0.74%) underwent severe hemorrhage after SRAE. This article retrospectively analyzed the characteristics of bleeding and the timing of SRAE in these 16 patients. Results Of the 16 patients, 15 cases were successfully treated with SRAE hemostasis in one time. However, one case of simple renal artery angiography (RAA) was performed before or after SRAE. One case was successful in 2 cases of SRAE hemostasis. In all patients, the mean hemoglobin decreased by 32.9g / L at the first RAA / SRAE and the average blood transfusion was 250mL. On the other hand, the average hemoglobin level decreased by 3.2g / L when the RAA / SRAE was performed again. Fifteen patients were successfully discharged and one died. Conclusions SRAE should be performed as soon as possible in patients with severe bleeding after PCNL. SRAE should be performed on patients who are negative on initial RAA or rebleeding after SRAE.