Urology and Lithotripsy Center, Peking University People's Hospital, Peking, China.
The Institute of Applied Lithotripsy Technology, Peking University, Peking, China.
Urol Int. 2020;104(9-10):797-802. doi: 10.1159/000508797. Epub 2020 Jul 7.
The aim of this study was to evaluate the characteristics of the renal arterial segment bleeding and assess the outcome of selective renal artery embolization (SRAE).
Data on 35 patients in whom SRAE was performed after percutaneous nephrolithotomy (PCNL) from January 2005 to December 2015 in our institute were retrospectively analyzed. All patients had severe bleeding but failed to respond to conservative therapy.
Forty-four SRAEs were performed in 35 patients (36 kidney units) after PCNL. The findings of 44 renal arteriographies before embolization revealed bleeding in 44 renal artery branch segments. Upper artery segment bleeding in 0, upper and anterior segment bleeding in 3, lower and anterior artery segment bleeding in 6, lower artery segment bleeding in 9, posterior artery segment bleeding in 24, and negative finding in 2 patients. Renal arteriography revealed pseudoaneurysms in 20 (45.5%) patients, arteriovenous fistulas in 6 (13.6%) patients, renal artery branch laceration in 16 (36.4%) patients, and negative angiography finding in 2 (4.5%) patients. Acute bleeding in 7 patients (20.0%) and delayed bleeding in 28 patients (80.0%) were observed. The target vascular lesions were successfully treated by embolization in the first time in 28 cases. Six patients underwent 2 sessions and 1 had 3 sessions. New vascular lesions were the most common cause of failure of initial SEAE in our hospital. Abnormal renal function was observed in 5 patients, and they recovered to preoperative or normal level within 3 weeks.
The posterior artery segment of the kidney is the most common bleeding site due to the choice of puncture site. Delayed bleeding (>24 h) was the most common type of bleeding. SRAE is an effective and safe method to treat the severe bleeding after PCNL.
本研究旨在评估经皮肾镜碎石取石术后（PCNL）选择性肾动脉栓塞（SRAE）中肾动脉节段性出血的特点，并评估其治疗结果。
回顾性分析 2005 年 1 月至 2015 年 12 月期间我院 35 例因 PCNL 后严重出血而接受 SRAE 治疗的患者数据。所有患者均经保守治疗无效。
35 例患者（36 个肾脏单位）共进行了 44 次 SRAE。栓塞前的 44 次肾动脉造影显示 44 个肾动脉分支节段有出血。上段动脉节段出血 0 例，上段及前节段出血 3 例，下段及前节段出血 6 例，下段动脉节段出血 9 例，后节段动脉节段出血 24 例，2 例阴性。20 例（45.5%）患者肾动脉造影显示假性动脉瘤，6 例（13.6%）患者显示动静脉瘘，16 例（36.4%）患者显示肾动脉分支撕裂，2 例（4.5%）患者血管造影阴性。7 例（20.0%）患者为急性出血，28 例（80.0%）患者为迟发性出血。28 例患者的目标血管病变在第一次栓塞治疗中得到成功治疗，6 例患者进行了 2 次治疗，1 例患者进行了 3 次治疗。在我院，新的血管病变是初次 SEAE 失败的最常见原因。5 例患者出现肾功能异常，3 周内恢复至术前或正常水平。
由于穿刺部位的选择，肾脏后节段是最常见的出血部位。迟发性出血（>24 小时）是最常见的出血类型。SRAE 是治疗 PCNL 后严重出血的有效、安全方法。
