腎臟出血之放射學診斷及治療：超選擇性與改良性動脈栓塞術

Radiologic Diagnosis and Therapeutic Angiography for Renal Hemorrhage-Superselective Versus Modified Arterial Embolization

蕭海松(Hai-Sung Hsiao) ； 李三剛(San-Kan Lee) ； 何善平(Peter S. P. Ho) ； 張聖源(Sun-Yrun Chang)

《中華放射線醫學雜誌》 14卷1期 (1989/03) Pp. 37-44

摘要

持續性大量腎出血，傳統之治療方法為全腎切除或局部腎切除。近十幾年來，由於血管攝影技術之進步，而能確實地瞭解腎出血之位置、大小與範圍；超選擇性動脈栓塞法(superselective arterial embolization)已逐漸被採用來治療體內器官之出血。三軍總醫院自民國72年9月至77月3月，共有18例大量腎出血之病例，接受腎動脈攝影(renal arteriography)，以假性動脈瘤(pseudoaneurysm)發生最多(13例)，其次為動脈與腎盞瘻管(arterio-caliceal fistula) （11例），動靜脈瘻管(arterio-venous fistula) （7例），與6例為腎內、外血腫塊(hematoma)。每一病例均施以經動脈栓塞術，其中13例接受超選擇性動脈栓塞術，佔72%；另5例(28%)無法利用超選擇性動脈栓塞法，而利用改良性(modified)栓塞法來完成動脈栓塞術。動永栓塞術成功率為100%，避免了外科腎切除術。

關鍵字

腎出血 ； 動脈栓塞術

並列摘要

Therapeutic angiography can replace surgery in controlling renal hemorrhage of various origins which include trauma, postbiopsy, percutaneous nephrostomy or nephrolithotomy and tumor bleeding. From Sept. 1983 thru March 1988, 18 patients with massive renal hemorrhage were successfully managed by superselective or modified arterial embolization with gelfoam particles or autologous clot. We analysed the angiographic finding and described the two different methods of transcatheter arterial embolization been used to control renal hemorrhage. The results showed that renal hemorrhage was associated with pseudoaneurysm (13 cases), arteriocalciceal fistula (11 cases), arteriovenous fistula (7 cases) and intrarenal or perirenal hematoma (6 cases). Superselective segmental arterial embolization was performed in 13 cases of massive renal hemorrhage, while in 5 cases who failed in this procedure were further managed by modified arterial embolization. This method is manipulated by causing temporary spasm of the normal intrarenal arteries by guide wire or catherter then injected embolic material into the bleeding vesseles. All of these patients were devoid of surgical intervention. Gross hematuria were resolved in all patients in 1-2 days after catheter hemostasis. There was no hypertension or renal failure during the follow-up period of ten days to two months.
We concluded that therapeutic arterial embolization is a safe and simple technique, and can be considered as the primary procedure for controlling massive renal hemorrhage. Modified arterial embolization will be recommended procedure if superselective embolization was failed.

並列關鍵字

renal hemorrhage ； arterial embolization