| Objective To explore the sensitivity of contrast-enhanced ultrasonography (CEUS) in diagnosis renal injuries complicated with active bleeding of different velocity, and quickly evaluate the related factors of traumatic degree. To explore the feasibility of percutaneous injective therapy for renal injuries by CEUS guided.Methods (1) In diagnostic experiment,15 lesions of renal injuries were made in 10 New Zealand rabbits. CEUS, CT, DSA, and BPI were used to observe velocity of active bleeding.34 lesions of renal injury were made in 4 dogs and 6 New Zealand rabbits. Two and three dimensional CEUS, CECT were used to study the relationship between the severity of trauma and ultrasonic observing indexes, including traumatic extension, different velocity of active bleeding, involving in vessels, and so on.58 patients with ranal injuries were observed by CEUS to study the relation between angiographic features and treatment prognosis. (2) In the first treatment experiment,10 trauma lesions were made in 3 New Zealand rabbits to study optimal injection routes and target of drug. (3) In the second treatment experiment,18 hepatic and 12 renal injury lesions in 6 New Zealand rabbits were randomly divided into three groups. Each group was injected respectively under guided by CEUS hemocoagulase (group A), a-cyanoacrylate (group B), hemocoagulase and a-cyanoacrylate (group C) to study their injective models and rational dosage. (4) In the third treatment experiment,24 kidney injuries were induced imitating a gradeⅢ-Ⅳblunt injury in 24 New Zealand rabbits. The animals were randomly divided into four groups. According to optimal injective models and rational dosage in previous studies, each group (6 animals) was treated individually with hemocoagulase and a-cyanoacrylate (GroupA), hemocoagulase (Group B), a-cyanoacrylate(Group C), and saline (Group D). At different set time after treatment, the haemostatic situation of all animals were observed, including hemostatic time, hemostatic effect, haematoma of renal peripheral, and impairment of lesions, and so on. (5) In clinical treatment study,37 cases with gradesⅡ-Ⅳrenal injuries were brought into our study, which of 58 patients with renal trauma were diagnosed by CEUS. According to wound degree and accompanying with active bleeding, they were divided into experiment group (Percutaneous injective hemostatic treatment) and control group (conservative treatment).Results (1) Which of 15 renal injuries lesions complicating with active bleeding, CEUS display 13 lesions, and the sensitivity is 87.5%(13/15). CEUS disply that contrast agent fast effuse in 5 lesions, and consecutively flee in 4 lesions, and intermittently overflow in 4 lesions from bleeding point to ruptured spot and renal pelvis. Research find that the severity of renal injuries is related to not only traumatic extension but also different velocity of active bleeding, and involving in vessels, and increasing of peritoneal fluid. (2) In the first treatment experiment, when drugs were given through rupture in 3 lesions, a coarse film of a-cyanoacrylate were formed, which was easily tear up and brought out when needle was draw, then film break away from lesions as bleeding overflowing. When drugs were given through hematoma in 3 lesions, coarse film were formed respectively in lesions and shot, which one of film was tear up and brought out when needle was draw. When drugs were given through a section of normal tissue in 4 lesions, a-cyanoacrylate overflowed from rupture lesions and formed a fast and smooth film adhesive, and then needle was retracted safely. (3) In the second treatment experiment, when 0.3 ml hemocoagulase was injected, bleeding became slow in Group A, and an unsolidified haemostatic film was formed in local. When 0.2mlα-cyanoacrylate was injected in Group B, a consistent film adhesive was formed and overlaid on the surface of lesions. After a few seconds, it separated from lesions as blood overflowing. When 0.3ml Hemocoagulase and 0.1ml a-cyanoacrylate were consecutively injected in Group C, a complete and firm haemostatic film was formed. When they were under dose of medication, active blooding couldn't become slow or film can't cover completely lesions. When they were over dose of medication, film would be thick and coarse than other groups. (4) In the third treatment experiment, haematoma of renal peripheral were observed at an hour after treatment, and those of test groups (A, B and C) were (0.05±0.002)cm, and (0.20±0.012)cm, and (0.40±0.009)cm. There were statistical significance between three test groups and control group (0.48±0.047)cm, (P<0.05). The results showed three test groups achieved hemostatic effect. At 7 and 14 days following treatment, CEUS observed size of lesions was (0.567±0.182)cm and (0.160±0.078)cm in group A, and was (1.207±0.143)cm and (0.433±0.163)cm in group B, and was (1.194±0.175)cm and (0.621±0.194)cm in group C, and was (1.680±0.167)cm and (0.686±0.157)cm in group D. The comparison between the test groups (A and B) and control group has statistical meaning (P<0.01). The comparison between group A and B has statistical meaning (P<0.01). It showed that the effects of group A were superior to group B. One month later, a slight nephrohydrosis occurrenced in groups A. (5) Vanishing time of hematuria and lesions, and hospital stay in experiment group (19 cases) was (0.60±0.043,10.353±2.473,4.800±1.005) days, and those of control group (20 cases) was (0.975±0.107,22.571±6.690,7.647±0.996) days. The the former was better than the latter with statistical meaning (P< 0.05).Conclusions (1) CEUS can exactly and completely reflect injury severity, and provide evidence for adopting further treatment. It will be important for guiding classification and evacuation. (2) Percutaneous injective therapy for gradeⅡ-Ⅳrenal injuries under guided by CEUS may be used for effective, minimally invasive control of renal injuries, and can be a feasible management of active bleeding at bedside.
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