自发性肾破裂病因分析及临床诊治  

Etiological analysis and clinical experiences of diagnosis and treatment in spontaneous renal rupture

作　　者：秦军 王福利 秦卫军 杨力军 秦荣良 袁建林 QIN Jun;WANG Fu-li;QIN Wei-jun;YANG Li-jun;QIN Rong-liang;YUAN Jian-lin(Department of Urology,Xijing Hospital,Air Force Military Medical University,Xi＇an Shaanxi 710032,China)

机构地区：[1]空军军医大学西京医院泌尿外科,陕西西安710032

出　　处：《局解手术学杂志》2018年第11期814-817,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省科技统筹创新工程项目(2012KTCL03-03)

摘　　要：目的探讨自发性肾破裂的发病原因,总结临床诊治经验。方法回顾性分析我院2001年1月至2014年12月收治的68例自发性肾破裂患者的临床资料,结合患者治疗结果,分析本病的病因、诊断措施和治疗策略。结果肾破裂出血的病因包括肾血管平滑肌脂肪瘤、肾细胞癌、肾感染性病变、肾小管变性坏死、肾输尿管结石、输尿管癌、肾血管病变等。68例患者中,保守治疗30例,手术治疗38例,全部患者经治疗后痊愈出院。1例肾细胞癌患者术后10个月因肿瘤远处转移而死亡,其余病例随访至今均未再次发生肾破裂出血、无肿瘤复发及远处转移,肾功能恢复良好。结论自发性肾破裂的最常见病因是肾血管平滑肌脂肪瘤,该病明确诊断需行CT扫描。治疗时须首先明确病因,并结合患者病情制定个体化治疗方案。Objective To analyze the etiology of spontaneous renal rupture,and to summarize the clinical experiences of diagnosis and treatment. Methods The clinical data of 68 patients with spontaneous renal rupture in our hospital from January 2001 to December 2014 were retrospectively analyzed,and the etiological factors,diagnostic measures and therapeutic strategies were summarized by checking patients outcomes. Results The causes of renal rupture and hemorrhage included renal angiomyolipoma,renal cell carcinoma,renal infectious disease,renal tubular degeneration and necrosis,renal and ureteral calculi,ureteral carcinoma,renovascular disease,and so on. Among the 68 patients,30 were treated conservatively and 38 were treated surgically. All 68 patients were discharged as cured. One patient with renal cell carcinoma died of distant metastasis at 10 months after operation. Up to date,the remain 67 patients have no further renal rupture bleeding,no tumor recurrence and distant metastasis,and the patients’ renal function were recovered well. Conclusion The main cause of spontaneous renal rupture is renal angiomyolipoma,and CT is the first choice of diagnostic procedure. The individualized therapeutic strategy is preferred according to the specific condition of the patient under the condition of defining the etiology.

关 键 词：Wunderlich综合征 肾破裂 根治性肾切除术 肾功脉栓塞 肿瘤 

分 类 号：R692[医药卫生—泌尿科学]