CAJ | 학술논문

目的：分析经皮肾镜取石术(PCNL)术后出血肾动脉造影表现,探讨应用 NBCA 胶经导管超选择栓塞治疗术的有效性及安全性。方法对14例 PCNL 术后肾出血患者,实施肾动脉造影并使用 NBCA 对病变动脉行超选择性栓塞。回顾性分析其临床资料以了解 PCNL 术后肾动脉损伤位置、类型、栓塞结果,评价栓塞术的技术成功率、临床疗效及手术相关并发症。结果血管造影表现为：假性动脉瘤12例,其中3例伴动脉肾盏瘘,5例伴动静脉瘘。单纯动静脉瘘2例。14例患者均成功使用 NBCA 行超选择性动脉栓塞术。NBCA 用超液化碘油按1︰2~1︰4比例稀释,术中 NBCA 混合剂用量0.1~0.2 mL。手术成功率100%。术后出血症状消失,无再出血病例,无器官坏死并发症。结论假性动脉瘤是 PCNL 术后大出血肾动脉损伤最常见的异常表现,使用 NBCA 胶经微导管超选择栓塞治疗安全、有效。
목적：분석경피신경취석술(PCNL)술후출혈신동맥조영표현,탐토응용 NBCA 효경도관초선택전새치료술적유효성급안전성。방법대14례 PCNL 술후신출혈환자,실시신동맥조영병사용 NBCA 대병변동맥행초선택성전새。회고성분석기림상자료이료해 PCNL 술후신동맥손상위치、류형、전새결과,평개전새술적기술성공솔、림상료효급수술상관병발증。결과혈관조영표현위：가성동맥류12례,기중3례반동맥신잔루,5례반동정맥루。단순동정맥루2례。14례환자균성공사용 NBCA 행초선택성동맥전새술。NBCA 용초액화전유안1︰2~1︰4비례희석,술중 NBCA 혼합제용량0.1~0.2 mL。수술성공솔100%。술후출혈증상소실,무재출혈병례,무기관배사병발증。결론가성동맥류시 PCNL 술후대출혈신동맥손상최상견적이상표현,사용 NBCA 효경미도관초선택전새치료안전、유효。
Objective To analyze the manifestation of renal artery angiography and discuss the effectiveness and safety of super-selective embolization using N-butyl cyanoacrylate (NBCA)for severe hemorrhage after percutaneous nephrolithotomy (PCNL). Methods Renal angiography and super-selective embolization with NBCA were performed in 14 patients for severe hemorrhage after PCNL.A review of medical charts were performed to gather information regarding the site,and type of bleeding lesions,and the re-sult of the embolization procedure.The technical and medical success,and technical and medical complications of the procedure were evaluated.Results Renal angiography revealed pseudoaneurysm in 12 cases,including 3 cases with arterial fistula calyx,5 cases with arteriovenous fistula,and simple arteriovenous fistula in 2 cases.14 patients were successfully performed by super-selective em-bolization .NBCA and iodized oil was mixtured at a 1 ︰ 2-1 ︰ 4 ratio,0.1-0.2 mL of NBCA with lipiodol was used for each pro-cedure.Technical succes rate was 100%.In all cases,hemorrhage stopped .No ischemic necrosis of organ,and no recurrence of re-nal hemorrhage were seen.Conclusion Pseudoaneurysm is the most common abnormal manifestation of renal artery hemorrhage af-ter PCNL.Super-selective embolization of the renal artery with NBCA is a safe and feasible procedure .