孤立肾动脉瘤一例报告并文献复习  

Solitary kidney with renal artery aneurysm ： one case report with literature review

作　　者：王丽娜[1] 宋希双[1] 杨德勇[1] 王建伯[1] 

机构地区：[1]大连医科大学附属第一医院泌尿外科,116011

出　　处：《中华泌尿外科杂志》2014年第9期655-658,共4页Chinese Journal of Urology

摘　　要：目的 总结孤立肾动脉瘤的治疗经验. 方法 回顾性分析2012年5月3日收治的1例孤立肾动脉瘤患者的临床资料,男,48岁.因高血压病10年,血压控制不理想就诊.血压最高达180/100 mmHg（1 mmHg=0.133 kPa）.实验室检查血肌酐64 μmol/L.彩色多普勒超声检查：左肾未探及,右肾体积增大,右肾门处肾动脉局限性扩张,范围21 mm×14 mm.CT检查：右肾动脉局限性扩张,考虑为动脉瘤可能;左肾未显示.肾动脉CT血管造影检查：左肾缺如,右肾动脉近肾门处可见一大小约17.1 mm×19.1 mm囊袋状凸出影,位于肾动脉主干远端分叉处,累及2根分支动脉,边缘光滑,形态欠规整,余肾动脉段及其远端分支血管显影良好,未见明显狭窄.诊断为右孤立肾动脉瘤.全麻下行右肾动脉瘤夹闭术,术中血压控制在70/40 mmHg.取右11肋间切口,显露肾动脉,可见一动脉瘤,直径约25 mm,基底部宽约19 mm,位于肾动脉主干,骑跨于2根肾动脉分支上.仔细分离动脉瘤,应用小肾蒂钳将近端肾动脉阻断,可见动脉瘤明显缩小,无菌冰局部覆盖肾脏后,应用2枚11 mm脑科动脉瘤夹,从动脉瘤两端平行于肾动脉向中心夹闭,中间部分紧密重合,动脉瘤壁予以绞索式缝合,松开肾蒂钳可见动脉瘤无膨大,血压回升至120/80 mmHg,立即静脉推注呋塞米20 mg,以保护肾功能. 结果 手术顺利,手术时间75 min,术中肾动脉阻断15 min,术中失血量约50 ml.未出现围手术期并发症.术后即刻和第1天复查血肌酐分别为95 μmol/L和150μmol/L,术后2周降至74μmol/L.术后血压控制良好,稳定于130/80 mmHg左右. 结论 孤立肾动脉瘤临床罕见.肾动脉瘤夹闭术是一种安全、有效、可行的治疗方式,尤其是对于孤立肾的患者能够达到理想的治疗效果.Objective To summarize the treatment experience of the solitary kidney with renal artery aneurysm.Methods Clinical data of 1 solitary renal artery aneurysm patient treated in our hospital in May.2012 was retrospectively analyzed.The 48 yrs man with a history of hypertension for 10 years,but responded to medical treatment poorly.The highest blood pressure was up to 180/100 mmHg （1 mmHg =0.133 kPa）.Preoperative check found that the serum creatinine was 64 μmol/L.Color Doppler ultrasound showed no detection of left kidney,the renal artery enlarged to the range of 21 mm× 14 mm.CT scan showed that the right renal artery locally enlarged,suggesting artery aneurysm.Renal computerized tomography angiography showed that left renal agenesis,right renal with artery aneurysm close to the renal hilum with size of 17.1 mm× 19.1 mm,was located on the distal renal artery bifurcation,involving 2 artery branches.The diagnosis was right solitary kidney with renal artery aneurysm.Renal aneurysm clip occlusion was performed under general anesthesia,blood pressure was controlled to 70/40 mmHg during the procedure.After exposing the renal artery,the renal artery was visible with a diameter of 25 mm and with a basement width about 19 mm,which located in the main renal artery and overrode the branches of the two renal arteries.After the clamp of the artery aneurysm from two sides to center and the middle part of it was overlapped,the artery aneurysm reduced obviously,and clipped the aneurysmal wall with noose suture.When loosen the clamp of main renal artery,the artery aneurysm was not enlarged,blood pressure up to 120/80 mmHg.Results The operation was successful,operation time was 75 min,intraoperative blocking time was 15 min,intraoperative blood loss was 50 ml,and there was no intraoperative and postoperative complication.Postoperatively immediate and the first postoperative day serum creatinine were 95 μmol/L and 150 μmol/L.2 week after surgery the index decreased to 74 μmol/L.After operation the blood pressure was control

关 键 词：孤立肾 动脉瘤 夹闭术 

分 类 号：R699.2[医药卫生—泌尿科学]