Ren Y M, Wu X M, Wen Y, Lai Q, Chen W Z, Qian Y X, Liang R G
Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Zhonghua Yi Xue Za Zhi. 2017 Jan 3;97(1):22-25. doi: 10.3760/cma.j.issn.0376-2491.2017.01.006.
To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage. A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied. The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm (=12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula(=2), recanalization of the embolized arteries (=2). The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.
探讨选择性肾动脉栓塞术治疗经皮肾镜取石术后出血后再出血的原因及对策。回顾性分析2011年3月至2015年4月期间334例经皮肾镜取石术（PCNL）相关严重肾出血患者的临床资料。所有患者均接受了超选择性血管造影及肾动脉栓塞术。分析再出血原因，研究诊断及栓塞原则。广州医科大学附属第一医院收治的329例患者接受了首次栓塞治疗，其中318例出血成功止住，止血成功率为96.7%（318/329）。在这334例连续病例中，有16例出现肾再出血，其中11例首次栓塞治疗在本院进行，另外5例在其他医院进行。再出血原因包括微小假性动脉瘤漏栓（=12），其中2例微小假性动脉瘤由副肾动脉供血，动静脉瘘未被发现（=2），栓塞动脉再通（=2）。经皮肾镜取石术后出血首次选择性肾动脉栓塞治疗后再出血的原因多样，微小假性动脉瘤漏栓是首次肾动脉栓塞治疗失败的主要原因。加强对微小假性动脉瘤的认识有助于提高止血成功率。
