选择性肾动脉造影及栓塞治疗肾出血疾病

目的探讨选择性肾动脉造影及栓塞在肾出血性疾病治疗中的作用。方法对15例保守治疗无效的肾出血患者行选择性肾动脉栓塞术。其中医源性肾脏损伤10例;肾脏错构瘤3例;肾脏闭合性损伤2例。结果肾动脉造影显示15例肾出血患者均有肾段或肾段以下动脉损伤,遂以单纯明胶海绵颗粒栓塞2例,单纯钢圈5例,明胶海绵和（或）PVA联合钢圈8例。随访13个月,2例未接受超选择栓塞者致脓肿形成,1例单纯明胶海绵栓塞1个月后出现血尿,经保守治疗后好转,余患者无再出血,患者肾功能无明显下降。结论对于肾出血性疾病,保守治疗效果欠佳时应尽早行肾动脉造影以明确诊断,且超选择性栓塞效果可靠,并发症轻微,尤其适用外科术后和肾脏功能储备低下的患者。

Selective renal artery angiography and embolization for nephrorrhagia diseases

Objective To assess the value of selective renal arteriography and embolization in the therapy of nephrorrhagia diseases. Methods Fifteen patients of renal hemorrhages including 10 iatrogenic renal trauma, 3 renal harmatoma and 2 renal closed injury with ineffective medical treatment underwent selective renal artery embolization. Results Renal artery angiographies confirmed renal segmental arteries and/or their branches injuries. Gelatin sponge, PVA or steel coil were used for embolization. During 1-3 months fllowing-up, renal abscess was found in 2 patients without superselective embolization, while haematuria occurred in one case after embolization with gelatin sponge but stopped after medical treatment. The renal function of all patients were normal after embolization. Conclusion Superselective renal artery embolization has reliable effect and slight complication in the treatment of nephrorrhagia, especially suitable for patients after surgery and renal inadequacy.