肾包膜下积液的外科治疗(附7例报告)  

Surgical management of renal subcapsular fluid collection

作　　者：杨志尚[1] 吴大鹏[1] 宋文斌[1] 

机构地区：[1]西安交通大学医学院第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2010年第6期433-434,442,共3页Journal of Modern Urology

摘　　要：目的探讨肾包膜下积液的外科治疗。方法回顾性分析7例肾包膜下积液的病因、治疗经过。其中男性4例,女性3例。3例男性和1例女性患者由体外震波碎石（ESWL）引起,1例女性由输尿管镜检引起,其余2例无明显原因。同位素分肾功能检查均有患侧肾小球滤过率下降,2例有高血压和血管紧张素及醛固酮水平升高（Page肾）。7例均行肾包膜切除术,手术均顺利完成。结果随访6~24月（平均11月）,无1例肾包膜下积液复发。2例高血压患者术后4周血压逐渐降至正常,复查血中血管紧张素和醛固酮水平正常。5例患肾功能完全恢复,2例3月后患肾的肾小球滤过率较对侧下降15%和25%。结论对外伤和医源性肾包膜下积液或积血患者要严密观察,有肾性高血压或患肾功能减退者应积极外科治疗,防止发生不可逆性肾功能损害。腹腔镜肾纤维膜切除应为首选方法,严重患者行肾切除。Objective To evaluate surgical management of renal subcapsular fluid collection.Methods Seven cases of renal subcapsular fluid collection treated with surgical therapy were analyzed retrospectively,4 of which were caused by extracorporeal shock-wave lithotripsy（ESWL）,1 by ureteroscopy,and 2 had no obvious causes.Two patients suffered from Page kidney.Glomerular filtration rate（GFR） decreased in all patients.All patients underwent capsulectomy.Results With follow up of 6~24 months（mean 11 months）,there was no complication of operation found.Renal function recovered completely in 5 cases and GFR decreased in 2 cases.Blood pressure became normal in the 2 patients with Page kidney.Renal subcapsular fluid collection did not recur.Conclusions Renal subcapsular fluid collection should be considered in all patients who suffered renal trauma or iatrogenic renal injuries.Laparoscopic capsulectomy may be the best therapy method for patients with Page kidney or decreased renal function caused by renal subcapsular fluid collection.Nephrectomy should be performed for selected cases.

关 键 词：PAGE肾 肾包膜下积液 并发症 肾包膜切除术 

分 类 号：R699.2[医药卫生—泌尿科学]