超選擇性動脈栓塞法控制腎出血

SUPERSELECfIVE ARTERIAL EMBOLIZATION: AS ATHERAPEUTIC TECHNIQUE FOR RENAL HEMORRHAGE

胡華堃(Hwa-Koon Wu) ； 蔣咸嘉(Hsien-Jar Chiang) ； 楊斐適(Fi-Sh Yang) ； 黃倫奕(Lun-Yick Wong) ； 羅景易(King-Yik Lo)

《中華放射線醫學雜誌》 12卷2期 (1987/06) Pp. 113-121

摘要

大量腎出血非常難以用保守療法處理，臨床上常需外科處理，做腎切除或局部腎切除（partial nephrectomy）近十年來，由動脈栓塞法（arterial embolization）之發展而漸漸被用來處理體內臟器難以控制的出血。馬偕醫院自民國72年12月至74年8月共經歷八例持續性難以控制之腎出血；其中二例目做經皮腎造瘻摘石術（percutaneous nephrolithotomy），後發生遲延性腎出血（delayed renal bleeding），三例做腎穿刺病理切片檢查後持續性血尿，一例車禍腎鈍傷發生單側腎出血，一例先天性腎動脈畸形（arteriovenous malformation），一例腎血管瘤（renal hemagiorna）。八例均施以超選擇性局部腎動脈栓塞法治療（superselective segmental arterial emboli-zation）。七例肉眼可見血尿（gross hematuria）消失，一例肉眼可見血尿得以明顯改善而轉成顯微性血尿（microscopic hernaturia）。治療成功率為87%。做完腎動脈栓塞後，發燒（38 - 39℃）有三例，沒有高血壓按其它器官被栓塞之合併症。腎動脈栓塞療法可有效而迅速處理大量腎出血。

並列摘要

Massive renal hemorrhage controlled by surgical intervention generally results in nephrectomy or at least partial nephrectomy. Recently, arterial embolization has been used to treat renal bleeding uncontrolled by medical or surgical management. Superselective segmental arterial embolization was performed in 8 patients for renal hemorrhage: Two in postpercutaneous nephroureterolithotomy, three in post-renal biopsy, one in post-traumatic contusion, one in congenital renal arteriovenous malformation and one in renal haemangioma. Gross haematuria resolved in seven of the eight cases after embolization, while the remaining one patient improved and became microscopic haematuria. No serious complication were noted except mild elevation of body temperature (38-39 C) in three patients. In conclusion, selective arterial embolization is a safe and fast technique for controlling massive renal haemorrhage.