Hom D, Eiley D, Lumerman J H, Siegel D N, Goldfischer E R, Smith A D
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
J Urol. 1999 Jan;161(1):24-7.
Simple nephrectomy is technically demanding in patients with recurrent inflammation or bleeding. It is also unwise to subject patients in poor health to the rigors of an extensive operative procedure. We report our experience with complete renal embolization as a safe and reliable alternative to surgical nephrectomy.
Eight patients underwent complete renal embolization as an alternative to nephrectomy. Patients were given antibiotics intravenously before and after embolization. Six patients with indwelling nephrostomy tubes received post-embolization instillation of 80 mg. gentamicin before tube removal. Narcotic analgesics were also given as needed for pain control. Post-embolization hospital course was noted.
The indications for embolization included hydronephrotic, poorly functioning kidneys with pain in 5 cases, and recurrent bleeding from angiomyolipoma, bleeding after percutaneous resection of renal pelvic transitional cell carcinoma with metastases and spontaneous renal bleeding after hemodialysis in 1 each. Embolization was successful in 4 men and 4 women with a mean age of 58.8 years. In 6 patients severe flank pain required narcotic analgesics. One patient complained of nausea, 6 had fever and 6 had leukocytosis. In 1 case thrombosis of a limb of an aortobifemoral bypass graft required thrombectomy. Median hospital stay was 2.5 days. At a mean followup of 30.6 months presenting symptoms had resolved in all cases without hypertension, renal failure or abscess.
Complete renal embolization is a viable alternative to nephrectomy in patients with poorly functioning kidneys who present with pain or bleeding and in those who are poor operative candidates. This procedure is safe, reliable and minimally invasive with few long-term sequelae, and it is well tolerated.
对于存在反复炎症或出血的患者，单纯肾切除术在技术上要求较高。让身体状况不佳的患者承受复杂的大型手术也是不明智的。我们报告了我们将完全性肾栓塞作为手术肾切除术的一种安全可靠替代方法的经验。
8例患者接受了完全性肾栓塞以替代肾切除术。栓塞前后均静脉给予患者抗生素。6例留置肾造瘘管的患者在拔管前接受了80毫克庆大霉素的栓塞后滴注。还根据需要给予麻醉性镇痛药以控制疼痛。记录栓塞后的住院过程。
栓塞的适应证包括5例肾积水、功能不良且伴有疼痛的肾脏，以及各1例血管平滑肌脂肪瘤反复出血、经皮切除肾盂移行细胞癌伴转移后出血和血液透析后自发性肾出血。栓塞成功应用于4名男性和4名女性，平均年龄58.8岁。6例患者出现严重的胁腹痛，需要使用麻醉性镇痛药。1例患者主诉恶心，6例发热，6例白细胞增多。1例患者的主动脉双股旁路移植血管分支发生血栓形成，需要进行血栓切除术。中位住院时间为2.5天。平均随访30.6个月时，所有病例的现有症状均已缓解，未出现高血压、肾衰竭或脓肿。
对于存在疼痛或出血且肾功能不良的患者以及手术风险较高的患者，完全性肾栓塞是肾切除术的一种可行替代方法。该手术安全、可靠且微创，长期后遗症少，耐受性良好。
