精索静脉取血辅助诊断一例肾素瘤的应用体会并文献复习  

Spermatic venous sampling in assisting the diagnosis of reninoma:One case report and literature review

作　　者：颜迪恩 杜志鹏[1] 冯正平[1] 宋颖[1] 何文雯[1] 彭富琴[1] 刘智平[1] 何一帆 甄乾娜[1] 李启富[1] 杨淑敏[1] Dien Yan;Zhipeng Du;Zhengping Feng;Ying Song;Wenwen He;Fuqin Peng;Zhiping Liu;Yifan He;Qianna Zhen;Qifu Li;Shumin Yang(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Endocrinology,Ji′an Central People′s Hospital,Ji′an 343000,China)

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016 [2]吉安市中心人民医院内分泌科,343000

出　　处：《中华内分泌代谢杂志》2021年第12期1112-1116,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81800701)。

摘　　要：探讨肾静脉及精索静脉取血在辅助诊断肾素瘤中的应用。回顾性分析1例肾素瘤患者临床资料及诊治经过,查阅肾静脉及精索静脉取血诊断肾素瘤的相关文献。患者为青年男性,因头痛伴高血压入院。入院后多次查血浆肾素>500 mIU/L,上腹部增强计算机断层扫描(CT)示左肾下极占位病变。静脉取血示左精索静脉肾素浓度明显高于肾静脉、肾静脉分支及外周静脉,考虑左肾素瘤可能,手术切除左肾占位,组织病检提示肾素瘤,患者术后肾素和血压恢复正常。文献报道肾静脉分段取血定位肾素瘤的阳性率仅8.3%~64%,推测可能与肾素瘤位于肾皮质,肿瘤血液由肾包膜静脉而非肾静脉收集有关。事实上,肾包膜静脉与精索静脉外侧支有交汇,但目前国内外尚未见精索静脉取血辅助定位肾素瘤的报道。鉴于肾素瘤分泌的肾素可能通过肾包膜静脉回流至精索静脉,肾静脉分段取血定位肾素瘤时应注意同时采集精索静脉血检测肾素。To investigate the renal venous and spermatic venous sampling in assisting the diagnosis of reninoma.The case of reninoma was retrospectively reviewed together with the literature review of reninoma diagnosed with renal venous and spermatic venous sampling.A young patient with hypertension and headache was admitted to our hospital.Laboratory test showed high plasma renin concentration(>500 mIU/L),and enhanced computed tomography(CT)in the upper abdomen showed a mass in left inferior renal pole.The concentration of renin in the left spermatic vein was significantly higher than that in renal veins and branches,and peripheral vein,which was considered the left reninoma possibility.The left renal mass was resected surgically and pathologic exam revealed reninoma.The renin level and the blood pressure recoveried normal after operation.The literature reported that the positive rate of renal vein segmental blood collection for locating renin tumor was only 8.3%-64%.The possible reason was that reninoma usually located in the renal cortex,and the tumor blood might be collected by renal capsule vein instead of renal vein.In fact,the renal capsule vein intersects with the lateral division of the spermatic vein,but there have been no reports about the localization of reninoma by spermatic vein sampling.Since renin secreted by reninoma may go into the spermatic vein through renal capsule vein,it should be noted that spermatic venous blood should be collected simultaneously in renal vein sampling when locating reninoma.

关 键 词：肾素瘤 肾静脉取血 肾素 醛固酮 精索静脉 

分 类 号：R737.11[医药卫生—肿瘤]