摘要目的 评价超选择性肾动脉栓塞治疗PCNL后严重出血的效果及其对肾功能的影响.方法 2008年5月至2010年2月,7例MPCNL术后严重出血患者,男5例,女2例.年龄28～68岁,中位年龄55岁.结石单发2例,多发5例,其中铸型结石2例.结石位于下组肾盏4例,中组肾盏1例,上组肾盏2例,肾盂和输尿管上段4例.患者术后平均10.7 d出血,出血持续l～14 d,总出血量600 ～1800 ml.实验室检查:SCr 77～186 μmol/L,平均94μmol/L；BUN 2.58～8.03 mmol/L,平均4.85 mmol/L.行超选择性肾动脉造影和弹簧钢圈栓塞治疗. 结果 肾动脉造影示假性动脉瘤6例,其中合并动静脉瘘1例；未显示出血灶1例.6例均成功地进行了肾动脉弹簧钢圈栓塞治疗,术后3～7d出血停止.术后2周复查SCr为59 ～ 98 μmol/L,平均78.3 μmol/L,BUN为1.86 ～ 6.92mmol/L,平均4.80 mmol/L. 结论 超选择性肾动脉栓塞治疗PCNL术后严重出血效果显著,肾功能受损轻,是临床首选的治疗手段.

abstractsObjective To evaluate the outcome of super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy (PCNL) and its effect on renal function. Methods From May 2008 to Feb 2010,severe bleeding occurred in 7 patients after PCNL in our hospital.(5 males and 2 females,average age of 54.9 years ).All cases were treated with super-selective renal angiography and 6 cases underwent microcoil embolization. Results Renal angiography showed pseudoaneurysm in 5 cases,pseudoaneurysm with arteriovenous fistula in 1 case and no severe bleeding in 1 case.Successful coil embolization was confirmed in 6 cases by angiography,and bleeding stopped within 3 -7 days after embolization.Serum creatinine and blood urea nitrogen were 59 -98 μmol/L(mean,78.3 μmol/L) and 1.86 -6.92 mmol/L( mean,4.8 mmol/L) 2 weeks after embolization,respectively. Conclusions Super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy has the advantages of remarkable hemostatic effects and mild impaired renal function,which is of the first choice.