Mitra Kakali, Prabhudesai Vikramaditya, James R Lester, Jones Robert W A, French Michael E, Cowling Mark, West David J
University Hospital of North Staffordshire NHS Trust, Newcastle under Lyme ST4 6QG, UK.
Cardiovasc Intervent Radiol. 2004 May-Jun;27(3):204-7. doi: 10.1007/s00270-003-1800-4. Epub 2004 Jan 23.
Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option.
Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.
Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis.
Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.
传统上，功能不佳的积水肾若出现症状就会被切除。在我们科室，会为患者提供肾动脉栓塞术作为一种替代治疗方案。
15例患者（11例男性，4例女性），平均年龄32.9岁（20 - 51岁），因功能不佳的症状性肾积水接受了肾动脉栓塞术。平均随访时间为64.13周（范围14 - 200周）。所有患者均有腰痛和肾积水。12例患者患有原发性肾盂输尿管连接部梗阻（PUJO）。2例患者因慢性结石梗阻继发功能不佳的积水肾。1例患者在先前因PUJO行肾盂成形术后，梗阻但功能尚可的肾脏出现慢性疼痛，需要干预。肾图检查的平均分肾功能为11%（范围0 - 46%）。在抗生素覆盖下，使用7F球囊闭塞导管以及无水乙醇、钢圈和聚乙烯醇颗粒进行选择性肾动脉栓塞。
9例患者出现栓塞后综合征，表现为自限性疼痛和发热，无脓毒症证据。1例患者因该情况需要再次入院。1例患者穿刺部位出现血肿。平均住院时间为2.3天。14例患者对结果满意，完全无痛。1例患者有轻微不适，但对结果感到高兴。9例患者接受了随访超声检查，证实肾积水已消退。
肾动脉栓塞术是终末期肾积水一种有效、安全、耐受性良好的微创治疗选择，我们常规将其作为肾切除术的替代方案提供给患者。
