The Study Of Effect And Timing Of Super-selective Renal Arterial Embolization In The Treatment Of Iatrogenic Renal Hemorrhage

Objective To explore the effect and the timing of intervention of super-selective renal artery embolization(SRAE)in iatrogenic renal hemorrhage,and to evaluate the effect of different embolization time on hemostasis and hospitalization.Methods The clinical data of 41 patients with iatrogenic renal hemorrhage treated with super-selective renal artery embolization from December 2011 to June 2019 in our hospital were retrospectively analyzed.The patients were divided into two groups according to the time interval between the occurrence of hematuria and interventional embolization.Group A with interval time ? 5 days and Group B with interval time> 5 days.The changes of HB,BUN and Scr values were compared between the two groups preoperative,postoperative 1 week and postoperative 1 month.In addition,the differences in clinical success rate,time of hematuria disappearance,amount of blood transfusion during hospitalization and length of hospitalization between groups A and B were compared.To investigate the effect of different embolization time on hemostasis and hospitalization.Results Among the 41 patients with iatrogenic renal hemorrhage,28 males(68.3%)and 13 females(31.7%)had an age distribution ranged from 35 to 69 years,with an average age of(50.95±9.63)years.There were 20 cases(48.8%)of left kidney injury and 21 cases (51.2%)of right kidney injury.Among the causes of iatrogenic renal hemorrhage,25 cases(61.0%)after percutaneous nephrolithotomy,11 cases(26.8%)after partial nephrectomy,3 cases(7.3%)after percutaneous nephrostomy,and 2 cases(4.9%)after renal biopsy.There were 2 patients(4.9%)with hemorrhagic shock,2 patients(4.9%)with urinary tract infection,2 patients(4.9%)with hypertension,and 1 patient with isolated kidney(no function of the other side).The HB values of postoperative 1 week and postoperative 1 month in group A and group B were both higher than those of preoperative,with statistically significant differences(p<0.01),while the BUN and Scr values of postoperative 1 week and postoperative 1 month in group A and group B were not significantly different from those of preoperative(p>0.05).The clinical success rate of groups A and B were 100%(21/21)and 90%(18/20),the time of hematuria disappearance were(1.71±0.72)d and(2.30±1.46)d,respectively.There were 2 cases and 2 cases of postoperative fever,and there were 3 cases and 5 cases of postoperative low back pain in the groups A and B,respectively,and the difference were not statistically significant(p>0.05).The amount of blood transfusion and the length of hospitalization after bleeding in groups A were significantly lower than that in groups B(616.67±756.20 ml vs.1430.00±1164.43 ml,9.52±3.19 dvs.17.50±4.50d),with statistically significant differences(p<0.05).There were no statistically significant difference in intraoperative angiography and the use of embolization materials between groups A and B(p>0.05).Conclusion(1)SRAE for iatrogenic renal hemorrhage is effective,safe and reliable,and can maximize the protection of renal function.It can be the first choice for patients who fail to respond to conservative treatment;(2)The timing of embolization has no significant effect on the therapeutic effect,while early embolization can reduce the amount of blood transfusion and hospital stay,so early intervention is recommended.