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目的:评价应用血管内栓塞技术治疗医源性肾损伤出血的安全性和疗效。方法:对34例医源性肾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(NBCA)-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例患者栓塞后出血停止,栓塞后30d内出院,4例术前伴有失血性休克及肾功能不全,栓塞后10d内死亡。30例患者随访5~48个月,均无再发出血及严重并发症。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的安全有效方法。
Objective: To evaluate the safety and efficacy of endovascular embolization in the treatment of hemorrhagic iatrogenic renal injury. Methods: Superselective renal artery embolization was performed in 34 patients with iatrogenic renal injury hemorrhage. The causes of injury were renal biopsy in 14 cases, partial nephrectomy in 8 cases, percutaneous nephrolithotomy in 8 cases, percutaneous pyelography in 3 cases, and percutaneous argon-helium knife in 1 case. Embolization materials include micro wire travelers, NBCA - lipiodol blends, polyvinyl alcohol microspheres, gelatin sponge nibs. Results: Selective renal artery angiography showed 21 cases of renal pseudoaneurysm, 8 cases of renal arteriovenous fistula and 10 cases of renal parenchymal rupture. The success rate of embolization was 100%. At the end of treatment, the contrast-enhanced blood vessels disappeared and the normal branches were preserved. Thirty patients stopped bleeding after embolization, were discharged within 30 days after embolization, 4 were hemorrhagic shock and renal insufficiency preoperatively, and died within 10 days after embolization. 30 patients were followed up for 5 to 48 months, no recurrence of bleeding and serious complications. Conclusion: Transcatheter selective renal artery embolization is a safe and effective method for the treatment of iatrogenic renal vascular injury.