肾出血急诊肾动脉造影特点及栓塞策略

目的探讨肾出血急诊肾动脉造影特点及栓塞策略。方法回顾性分析63例接受急诊肾动脉造影的肾出血患者,其中医源性操作致出血43例(医源性组)、非医源性操作出血20例(非医源性组),比较2组肾动脉造影表现、所用栓塞材料和止血效果。结果 45例造影可见阳性表现,18例造影阴性。医源性组造影阳性率79.07%(34/43)]高于非医源性组55.00%(11/20),P=0.049];2组造影阳性表现差异有统计学意义(P=0.001),医源性组以假性动脉瘤最常见,所用栓塞材料差异无统计学意义(P=0.090)。45例造影阳性病例中,41例经一次栓塞治疗后出血停止,一次栓塞成功率91.11%(41/45),2例经二次栓塞后出血停止,栓塞总成功率95.56%(43/45)。结论医源性操作所致肾动脉出血是急诊肾动脉造影的主因,造影阳性率高,其中假性动脉瘤最常见。选择性肾动脉栓塞治疗肾出血疗效较好。

Characteristics of emergency renal arteriography and embolization strategies for renal hemorrhage

Objective To investigate the emergency renal arteriographic characteristics and embolization strategies of renal hemorrhage. Methods Data of 63 renal hemorrhage patients who underwent emergency renal arteriography were retrospectively analyzed, including 43 cases of iatrogenic operation bleeding (iatrogenic group) and 20 cases of non-iatrogenic operation bleeding (non-iatrogenic group). The angiographic manifestations, embolic materials and hemostatic effects were compared between 2 groups. Results Positive findings were noticed in 45 cases, while 18 cases were angiographically negative, the positive angiography rate in iatrogenic group (79.07% 34/43]) was higher than in non-iatrogenic group (55.00% 11/20], P=0.049). There were statistical differences of angiographic positive findings between 2 groups (P=0.001). In iatrogenic group, pseudoaneurysm was the most common positive finding. No significant difference of embolic material used was found between 2 groups (P=0.090). Among 45 cases with positive findings, bleeding stopped in 41 cases after single embolization, (91.11%, 41/45), while in 2 cases stopped after the secondary embolization, and the embolization success rate was 95.56% (43/45). Conclusion Renal hemorrhage caused by iatrogenic operations are the main source of emergency renal arteriography with high positive rate mainly presenting as pseudoaneurysm. Selective renal artery embolization is the main and effective method for treatment of renal hemorrhage.