肾部分切除术后肾动脉假性动脉瘤一例并文献复习  

A case of renal artery pseudoaneurysm after partial nephrectomy and literature review

作　　者：李骏[1] 江东根 廖国龙 严彬元 杨祥伟 陈楚杰[1] 庞俊[1] 熊海云 Li Jun;Jiang Donggen;Liao Guolong;Yan Dinyuan;Yang Xiangwei;Chen Chujie;Pang Jun;Xiong Haiyun(Department of Urology,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 508107,China)

机构地区：[1]中山大学附属第七医院泌尿外科,深圳508107

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第5期378-381,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省医学科研技术研究基金资助项目(A2019555、A2019490)。

摘　　要：目的探讨肾部分切除术后少见但危重的肾动脉假性动脉瘤(RAP)的临床表现、诊断与处理方法。方法报告2019年8月我科诊疗的1例腹腔镜左肾部分切除术后出现RAP患者的临床资料,并复习相关文献对RAP的临床特征、诊断与治疗进行分析总结。结果患者男,77岁,因“发现左肾占位1个月”入院,术前诊断为“左肾占位:肾癌可能性大”。行腹腔镜下左肾部分切除术,术后病理结果示左肾透明细胞癌,包膜完整。术后第8天出现无痛性肉眼血尿,超声造影提示左肾RAP,介入下肾动脉造影再次确诊并同时行超选择性肾动脉栓塞,成功栓塞动脉后患者无再发血尿,顺利出院。结论RAP是肾部分切除术后少见但严重的并发症,可疑患者应尽早行超声造影检查,超选择性肾动脉栓塞治疗安全有效。Objective To investigate the clinical manifestations,diagnosis and treatment of the rare but serious renal artery pseudoaneurysm(RAP)after partial nephrectomy.Methods This paper reported the clinical data of a case of RAP after laparoscopic partial nephrectomy in our department in August 2019,and reviewed relevant literature to analyze and summarize the clinical characteristics,diagnosis and treatment of RAP.Results The male patient,77 years old,was admitted to the hospital because of finding left renal tumor for 1 month.Preoperative diagnosis was left renal tumor with high possibility of malignancy.Laparoscopic partial nephrectomy was performed.Postoperative pathological results showed clear cell carcinoma of the left kidney with intact capsule.Painless gross hematuria occurred on the 8th day after the operation,and contrast-enhanced ultrasonography suggested the left renal pseudoaneurysm.The diagnosis was confirmed by renal arteriography and super-selective renal artery embolization was performed at the same time.After successful embolization of the tumor carrier artery,the patient had no recurrence of hematuria and was discharged successfully.Conclusion RAP is a rare but serious complication after partial nephrectomy,suspected patients should be screened by contrast-enhanced ultrasound as soon as possible,and ultra-selective renal artery embolization is safe and effective therapy for RAP.

关 键 词：肾动脉假性动脉瘤 肾部分切除术 超声造影 肾动脉造影 超选择性肾动脉栓塞术 

分 类 号：R737.11[医药卫生—肿瘤]