el-Nahas Ahmed R, Shokeir Ahmed A, Mohsen Tarek, Gad Hossam, el-Assmy Ahmed M, el-Diasty Tarek, el-Kappany Hamdy A
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2008 Mar;71(3):408-12. doi: 10.1016/j.urology.2007.10.033.
To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization.
Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU).
Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 +/- 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 +/- 9% at the 3-month scans to 34 +/- 11% at the last follow-up scans (P <0.001).
The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.
评估经皮肾镜取石术（PCNL）后超选择性肾血管造影栓塞术的功能和形态学效果。
1995年1月至2006年3月期间，4095例PCNL手术中有41例（1%）术后需要超选择性肾血管造影来控制严重出血。我们在3个月后通过肾脏超声检查（RUS）、二巯基丁二酸（DMSA）肾扫描以及血清肌酐评估来评估栓塞的短期效果。我们通过RUS、DMSA肾扫描和排泄性尿路造影（IVU）评估长期的形态学和功能效果。
38例患者（93%）通过超选择性栓塞可控制出血。其中6例出现早期栓塞后并发症，4例为肾周血肿，2例为尿漏。3个月时，9例单肾患者中有3例血清肌酐水平升高，但均无需肾脏替代治疗。对30例患者进行了平均3.9±2.3年的长期随访。我们对27例患者进行了IVU检查。其中，2个肾单位（7%）无造影剂排泄。DMSA扫描显示6个肾单位（20%）放射性示踪剂分布均匀，无放射性缺损区。相应肾脏DMSA摄取的平均百分比从3个月扫描时的25±9%提高到最后一次随访扫描时的34±11%（P<0.001）。
超选择性肾栓塞治疗PCNL术后肾血管损伤的短期有害影响在单肾患者中更为明显。然而，长期随访显示功能和形态学有改善。
