41例肾错构瘤破裂出血的诊断及治疗  

Diagnosis and Treatment of 41 Cases with Rupture and Hemorrhage of Renal Hamartoma

作　　者：刘亮[1] 孙敏[1] LIU Liang;SUN Min(General Urology Ward,Urological Center,Xinjiang Uygur Autonomous Region people's Hospital,Urumqi,Xinjiang,830001 China)

机构地区：[1]新疆维吾尔自治区人民医院泌尿中心普泌病区,新疆乌鲁木齐830001

出　　处：《系统医学》2018年第22期63-65,共3页Systems Medicine

摘　　要：目的探究41例肾错构瘤破裂出血的诊断及治疗。方法回顾性分析该科自2008年4月—2017年4月收治肾脏错构瘤自发破裂出血患者41例的治疗方法、病理、随访结果,以及临床资料和影像学检查。结果 41例手术均取得成功,无中转开放手术,平均手术时间97 min(55～240)min,平局肾动脉阻断时间为33 min(20～55)min,术后复查肾功能均未见明显异常,1例患者术后继发出血,经栓塞治疗后好转,41例患者中7例患者因肾错构瘤破裂出血休克较重,术中输注红细胞悬液4 U,血浆400 mL,其余患者均未输血,所有病例均术中送快速冰冻,术中冰冻结果证实为良性肿瘤,术后常规病理石蜡切片或免疫组化均证实为肾脏血管平滑肌脂肪瘤。患者术后随访3～24月均未见肿瘤复发。术后并发症主要包括:发热、切口并发症、术后下肢深静脉血栓、术后慢性腰背部疼痛等。均给予患者对症治疗后缓解,康复出院。结论诊断肾错构瘤中,B超和CT是行之有效的影像检查。而需行手术治疗的,则尽可能保留肾单位,但是伴有破裂出血或者是肿瘤直径大的患者,需行开放肾部分切除术。腹腔镜肾部分切除术(LPN),是肿瘤直径较小者有效的外科治疗方式。除此之外,手术方式应根据肿瘤组织大小、部位和出血情况决定,尽可能选择保留肾脏手术,根据患者身体情况、患者意愿、手术医生手术技巧选择手术方式,肾脏错构瘤存在易于自发破裂出血的风险,病情发展快,容易出现出血性休克,因此我们认为对于肾脏错构瘤的治疗因积极主动,通过B超及CT等辅助检查明确诊断,积极手术治疗,尽量在患者出现肾脏错构瘤自发破裂出血前积极治疗,尽量保留患者患侧肾单位。Objective To study the diagnosis and treatment of 41 cases with rupture and hemorrhage of renal hamartoma. Methods The treatment method, pathology and follow-up results of 41 cases of patients with rupture and hemorrhage of renal hamartoma admitted and treated in our hospital from April 2008 to April 2017 were retrospectively analyzed, and the clinical data and imaging examination results were also reviewed. Results The operation of 41 cases was successful, without transforming to the open surgery, and the average operation time was 97 min(55~240)min, and the tie renal artery occlusion time was 33 min(20~55)min, and the renal function was not obviously abnormal by the postoperative reexamination, and 1 case had the secondary hemorrhage after surgery, and improved after the embolotherapy, and of 41 cases, 7 cases were infused with erythrocyte suspension 4 U and blood plasma 400 mL in operation due to the heavy renal hamartoma ruptured hemorrhagic shock, and the other patients were not infused, and the intraoperative frozen results proved they were benign tumors, and the postoperative routine pathological paraffin section or immunohistochemtry proved that they were renal angiomyolipoma, and the tumors did not reoccur in 3-24 months after the follow-up after surgery. The major complications after surgery included fever, incision complications, postoperative deep vein thrombosis and chronic low back pain after surgery, and the patients were relieved after the systematic treatment and discharged after rehabilitation. Conclusion The ultrasound B and CT are the effective imaging examination in diagnosis of renal hamartoma. For patients needing the operative treatment ,we should try nephron sparing, but for patients with ruptured hemorrhage or big tumor diameter, the open partial nephrectomy is needed, LPN is an effective surgical treatment method for patients with small tumor diameter, besides, the operative way should be determined according to the tumor tissue size, site and hemorrhage, and we should try to select to

关 键 词：诊断治疗 保留肾单位 肾错构瘤 

分 类 号：R737.11[医药卫生—肿瘤]