超选择性肾动脉栓塞术治疗微创经皮肾镜取石术后出血

经皮肾镜取石术后严重出血的动脉栓塞治疗陈云涛1，李立1，汪自力2，杨进2【摘要】　目的　总结超选择性肾动脉栓塞治疗经皮肾镜取石术后严重出血的临床经验。

方法　回顾分析2009年10月－2012年11月行经皮肾镜取石术后发生严重出血的6例（2.74%）患者的临床资料和对其进行超选择性肾动脉栓塞术的血管造影表现和栓塞疗效。

结果　患者平均年龄67岁，经皮肾镜取石术后急性出血1例，迟发出血5例，均有体外冲击波碎石史或糖尿病、高血压病史。

肾动脉造影显示损伤动脉为肾后下段动脉、肾下段动脉分支，表现为假性动脉瘤5例，动静脉瘘1例。

使用弹簧圈或聚乙烯醇颗粒超选择性栓塞，栓塞后出血无一例复发。

随访6个月，5例肾功能未见下降，1例受损。

结论　经皮肾镜术后严重出血与术中动脉损伤有关，采用超选择性肾动脉栓塞术能够达到迅速止血、尽可能保全患肾功能、有效挽救生命的诊疗效果。

【关键词】　经皮肾镜取石术；肾出血；超选择性肾动脉栓塞【文献标识码】　A DOI:10.7507/1002-0179.20130073Artery Embolization for Severe Hemorrhage aft er Percutaneous Nephrolithotomy　CHEN Yun-tao1, LI Li1,WANG Zi-li2,YANG Jin2. 1. Department of Radiology; 2. Department of Urology; Affi liated Hospital of Chengdu University, Chengdu, Sichuan 610081, P. R. China【Abstract】 Objective To summarize the clinical experience of interventional treatment of super-selective renal artery embolization for severe hemorrhage in patients with post-percutaneous nephrolithotomy (PCNL). Methods　From October 2009 to November 2012, super-selective artery embolization was used to control severe hemorrhage of 6 patients(2.74%). The clinical data and angiography manifestation of renal angiography and angio-embolization were reviewed.Results　The average age of the 6 patients was 67 years old. The history of 6 patients with either extracorporeal shock wave lithotripsy or hypertension or diabetes mellitus was revealed. Vessel injury to renal artery branches of posterior inferior or inferior segment was detected on renal angiography, and totally there were 5 pseudoaneurysms and 1 arteriovenous fi stulum respectively. The hemorrhage in all 6 patients ceased completely with spring coil or polyving akohol particles embolization;no patients with recurrence were found. During follow-up period within 6 months post-embolization, renal function was kept well in 5 patients whereas in 1 with renal damage. Conclusions　Severe hemorrhage in patients with PCNL is closely associated to operative arterial injury. It can be stanched by super selective arterial embolization.【Key words】　Percutaneous nephrolithotomy; Renal hemorrhage; Super-selective renal artery embolization论　著【作者单位】成都大学附属医院（成都，610081） 1放射科，2 泌尿外科【作者简介】陈云涛（1970－），男，浙江义乌人,副主任医师,本科, E-mail：cyt_70@【网络出版时间】 2013-02-06 18:31【网络出版地址】 /kcms/detail/51.1356.R.20130206. 1831.043.html 1　资料与方法1.1　临床资料本组6例患者，男4例，女2例。

立即通知医生，取健侧卧位
心电监护，氧气吸入
建立两条静脉通路，止血、抗感染，补充血容量
观察有无低血容量性休克临床表现，做好抢救准备
经皮肾镜取石术后大出血护理应急预案与流程
1.立即通知医生，绝对卧床休息，取健侧卧位。

2.密切观察生命体征变化，心电监护，低流量氧气吸入。

3.观察切口敷料渗血情况，肾造瘘管及尿管引流液的性质及量，正确评估出血程度。

如引流液持续为鲜红色，表明有活动性出血，必须密切观察出血情况，及时处理。

4.建立两条以上静脉通路，遵医嘱输入止血、抗感染类药物，补充血容量。

5.准确抽取血交叉配血标本，为输血做好准备。

6.密切观察有无低血容量性休克的临床表现，备抢救用物及药品，配合医生进行抢救。

7.加强基础护理，保持床单元干燥平整，使病人舒适。

8.大出血会引起患者恐慌心理，做好心理护理，稳定患者的情绪。

9.必要时，送手术室进行手术止血。

10.做好护理记录。

附：经皮肾镜取石术后大出血护理应急流程
书写护理记录
必要时，手术止血治疗
做好基础护理、心理护理，稳定患者情绪。