Zhao Yilei, Shen Baihua, Zhong Baishu, Xu Shunliang, Tan Fuqing
Department of Radiology, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, China.
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Zhonghua Yi Xue Za Zhi. 2014 Sep 16;94(34):2687-9.
To evaluate the clinical values of computed tomography angiography (CTA) for severe hemorrhage after percutaneous nephrolithotomy (PCNL).
A total of 50 patients with bleeding after PCNL were enrolled. All patients underwent renal artery CTA. There were 34 males and 16 females with an average age of 45.7 years. Left (n = 31) and right (n = 19) sides were affected. The criteria of severe bleeding included a one-off amount of bleeding over 400 ml after PCNL or/and hemoglobin decreased 20 g/L after PCNL.
Among them, CTA showed pseudoaneurysm (n = 24), arteriovenous fistula (n = 6), suspicious bleeding spot (n = 4) and no obvious bleeding spot (n = 16). And 24 pseudoaneurysm and 6 arterovenous fistula patients underwent digital subtraction angiography (DSA) immediately. The bleeding spots were successfully intervened and coil embolization treatment was performed. Three of 4 suspicious bleeding cases had rebleeding mini-pseudoaneurysms. The remaining one case of rebleeding was successfully controlled by conservative measures.
Renal artery CTA is the first-line screening technique for severe bleeding after PCNL. But for arterial hemorrhage patients, DSA examination may be directly conducted.
评估计算机断层血管造影（CTA）在经皮肾镜取石术（PCNL）后严重出血中的临床价值。
共纳入50例PCNL术后出血患者。所有患者均接受肾动脉CTA检查。其中男性34例，女性16例，平均年龄45.7岁。左侧（n = 31）和右侧（n = 19）均有受累。严重出血的标准包括PCNL术后一次性出血量超过400 ml或/和PCNL术后血红蛋白下降20 g/L。
其中，CTA显示假性动脉瘤（n = 24）、动静脉瘘（n = 6）、可疑出血点（n = 4）和无明显出血点（n = 16）。24例假性动脉瘤和6例动静脉瘘患者立即接受了数字减影血管造影（DSA）检查。出血点成功得到干预并进行了弹簧圈栓塞治疗。4例可疑出血病例中有3例出现再出血微型假性动脉瘤。其余1例再出血通过保守措施成功控制。
肾动脉CTA是PCNL术后严重出血的一线筛查技术。但对于动脉出血患者，可直接进行DSA检查。
