MSCT在介入治疗泌尿系统医源性出血中的应用
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摘要
目的探讨术前MSCT增强扫描对介入治疗泌尿系统不同部位医源性出血的价值。方法回顾性分析27例因泌尿系统不同部位医源性出血接受介入治疗患者的资料,比较术前MSCT增强扫描与术中首次DSA对出血责任血管的检出率,分析CT及DSA征象。结果 26例(26/27,96.30%)经术前MSCT增强扫描明确出血责任血管,主要表现为动脉期斑片状对比剂外溢、对比剂浓聚及肾静脉早期显影征象;1例未明确责任血管患者DSA可见动静脉瘘征象。24例(24/27,88.89%)经术中首次DSA明确出血责任血管,主要表现为对比剂外溢、假性动脉瘤及肾动静脉瘘;3例未明确责任血管患者术前MSCT增强扫描表现为对比剂外溢2例、肾静脉早期显影1例,术中参考术前增强MSCT表现调整后再次造影均明确责任血管。术前MSCT增强扫描与术中首次DSA对出血责任血管的检出率的差异无统计学意义(2χ=1.08,P=0.29)。结论介入治疗前MSCT增强扫描可较为准确地判定泌尿系统不同部位医源性出血责任血管,且对术中首次DSA无法明确出血责任血管患者可根据术前MSCT表现对DSA进行调整,从而快速、准确地进行栓塞。
Objective To observe the value of preoperative enhanced MSCT before interventional treatment of iatrogenic hemorrhage in different positions of urinary system.Methods Data of 27 patients underwent interventional therapy for iatrogenic bleeding in different positions of the urinary system were retrospectively analyzed.The detection rate of bleeding responsible vessels were compared between preoperative enhanced MSCT and the first time intraoperative DSA.CT and DSA findings were also studied.Results Bleeding responsible vessels were identified in 26patients(26/27,96.30%)with preoperative enhanced MSCT, mainly manifested as arterial plaque contrast agent extravasation,contrast agent concentration and early developing of renal vein.Sign of arteriovenous fistula detected with the first time intraoperative DSA was observed in 1patient without a clearly responsible vessel for bleeding using preoperative enhanced MSCT.In 24patients(24/27,88.89%),the responsible vessels for bleeding were identified with the first time intraoperative DSA,mainly manifested as contrast agent extravasation,pseudoaneurysm and renal arteriovenous fistula.Responsible vessels for bleeding were not detected with the first time intraoperative DSA in 3 patients who had characteristic findings of preoperative enhanced MSCT,including contrast agent extravasation in 2patients and early developing of renal vein in 1patient.With the reference of preoperative MSCT manifestations,bleeding responsible vessels were clearly detected with the second time DSA during operation.There was no significant difference of the detection rate of bleeding responsible vessel between preoperative enhanced MSCT and the first time intraoperative DSA(χ2=1.08,P=0.29).ConclusionBleeding responsible vessels of iatrogenic hemorrhage in different positions of urinary system can be detected accurately with preoperative enhanced MSCT.Enhanced MSCT images can also be used as the references for patients without clearly responsible vessel for bleeding using the first time intraoperative DSA of interventional therapy,so as to embolize the responsible vessel rapidly and effectively.
Objective To observe the value of preoperative enhanced MSCT before interventional treatment of iatrogenic hemorrhage in different positions of urinary system.Methods Data of 27 patients underwent interventional therapy for iatrogenic bleeding in different positions of the urinary system were retrospectively analyzed.The detection rate of bleeding responsible vessels were compared between preoperative enhanced MSCT and the first time intraoperative DSA.CT and DSA findings were also studied.Results Bleeding responsible vessels were identified in 26patients(26/27,96.30%)with preoperative enhanced MSCT, mainly manifested as arterial plaque contrast agent extravasation,contrast agent concentration and early developing of renal vein.Sign of arteriovenous fistula detected with the first time intraoperative DSA was observed in 1patient without a clearly responsible vessel for bleeding using preoperative enhanced MSCT.In 24patients(24/27,88.89%),the responsible vessels for bleeding were identified with the first time intraoperative DSA,mainly manifested as contrast agent extravasation,pseudoaneurysm and renal arteriovenous fistula.Responsible vessels for bleeding were not detected with the first time intraoperative DSA in 3 patients who had characteristic findings of preoperative enhanced MSCT,including contrast agent extravasation in 2patients and early developing of renal vein in 1patient.With the reference of preoperative MSCT manifestations,bleeding responsible vessels were clearly detected with the second time DSA during operation.There was no significant difference of the detection rate of bleeding responsible vessel between preoperative enhanced MSCT and the first time intraoperative DSA(χ2=1.08,P=0.29).ConclusionBleeding responsible vessels of iatrogenic hemorrhage in different positions of urinary system can be detected accurately with preoperative enhanced MSCT.Enhanced MSCT images can also be used as the references for patients without clearly responsible vessel for bleeding using the first time intraoperative DSA of interventional therapy,so as to embolize the responsible vessel rapidly and effectively.
引文
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[9]黄源义,周文辉,曹飞,等.选择性肾动脉栓塞在经皮肾镜取石术后迟发性肾出血中的应用.介入放射性杂志,2011,11(20):895-897.
[10] Malden ES, Hicks ME, Royal HD,et al. Recurrent gastrointestinalbleeding:Useofthrombolysiswith anticoagulation in diagnosis.Radiology,1998,207(1):147-151.
[11]胡跃峰,王承恩,杨暋敏,等.超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的临床研究.中国介入影像与治疗学,2017,14(8):460-463.
[12]杨晶,白彬,徐伟,等.动脉性肾出血的急诊介入栓塞治疗.实用放射学杂志,2016,32(7):1102-1105.
[2]徐伟,王法,梁宏伟,等.肾动脉CTA在急性肾出血栓塞治疗中的应用.医学影像学杂志,2013,23(7):1085-1088.
[3] Sommer CM,Stampfl U,Bellemann N,et al.Patients with lifethreatening arterial renal hemorrhage:CT angiography and catheterangiographywithsubsequentsuperselective embolization.Cardiovasc Intervent Radiol,2010,33(3):498-508.
[4]王长彬,刘健,张新毅,等.介入栓塞治疗在临床急症动脉性出血中的应用.医学影像学杂志,2016.26(2):296-298.
[5] Madhusudhan KS, Venkatesh HA, Gamanagatti S,et al.Interventional radiology in the management of visceral artery pseudoaneurysms:A review of techniques and embolic materials.Korean J Radiol,2016,17(3):351-363.
[6] Khawaja AT,Mclean GK,Srinivasan V.Successful intervention for high-output cardiac failure caused by massive renal arteriovenous fistula-a case report.Angiology,2004,55(2):205-208.
[7]牛国晨,杨敏,宋莉,等.肾动静脉瘘的腔内治疗.中国介入影像与治疗学,2016,13(6):325-328.
[8]朱聪辉,林文集,万建明,等.先天性肾动静脉畸形的影像表现与栓塞治疗.中国介入影像与治疗学,2015,12(3):156-159.
[9]黄源义,周文辉,曹飞,等.选择性肾动脉栓塞在经皮肾镜取石术后迟发性肾出血中的应用.介入放射性杂志,2011,11(20):895-897.
[10] Malden ES, Hicks ME, Royal HD,et al. Recurrent gastrointestinalbleeding:Useofthrombolysiswith anticoagulation in diagnosis.Radiology,1998,207(1):147-151.
[11]胡跃峰,王承恩,杨暋敏,等.超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的临床研究.中国介入影像与治疗学,2017,14(8):460-463.
[12]杨晶,白彬,徐伟,等.动脉性肾出血的急诊介入栓塞治疗.实用放射学杂志,2016,32(7):1102-1105.