自发性肾周出血的诊治(附31例报告)  

Diagnosis and treatment of spontaneous perirenal hemorrhage(report of 31 cases)

作　　者：余家琦[1] 杨国胜[1] 蔡松良[1] 彭弋峰[2] 刘卫平 陶凌松 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]皖南医学院弋矶山医院泌尿外科 [3]芜湖市第二人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2003年第8期524-526,共3页Chinese Journal of Urology

摘　　要：目的　探讨自发性肾周出血 (SPH)的诊治方法。　方法　对 31例SPH临床资料进行回顾性分析。男 13例 ,女 18例 ,平均年龄 4 2岁。左侧 17例 ,右侧 14例。腰背部疼痛 31例 ,腰腹部包块 10例 ,休克 8例 ,血尿、腹腔出血各 3例。CT诊断 18例 (18/19)、B超诊断 2 2例 (2 2 /2 9)、KUB加IVU诊断 7例 (7/14 )。　结果　 31例患者中 ,行肾切除术 18例、根治性肾切除术 1例、保留肾脏手术 4例、肾动脉栓塞术 2例、血肿穿刺引流 1例、保守治疗 5例。病理诊断肾血管平滑肌脂肪瘤 11例、肾囊肿 6例、肾癌 4例、肾感染 3例、肾动脉瘤和肾积水各 2例。 2 8例痊愈出院 ,3例术后血液透析治疗。　结论　SPH临床症状取决于出血程度和持续时间 ,主要表现为上腹部疼痛 ,以肾血管平滑肌脂肪瘤破裂多见。CT和B超是诊断SPH的首选方法 ,治疗方案应根据不同病因和出血情况确定。Objective To study the diagnosis and treatment of spontaneous perirenal hemorrhage(SPH). Methods The clinical data of 31 cases of SPH were reviewed retrospectively.In the 31 cases,flank pain,flank mass,shock,gross hematuria,abdominal bleeding occured in 31,10,8,3 and 3 cases,respectively.The final diagnosis was established on CT scan,B-ultrasonography and IVU were 18,22 and 7 cases. Results In 31 cases,nephrectomy were performed in 18,radical nephrectomy in 1 case,nephron spare surgery in 4,renal artery embolization in 2,inspiration and drainage of hemorrage in 1 and careful watching in 5 cases.There were 11 cases of angiomyolipoma,6 renal cyst,4 of renal cell carcinoma,3 infectious diseases,2 aneurysm of renal artery and 2 hydronephrosis. Conclusions The clinical presentation may vary greatly depending on the degree and duration of bleeding,and the severe pain in the upper abdomen of abrupt onset is the common sign and symptom.The spontaneous rupture of renal cell carcinoma and angiomyolipoma are the most common cause of SPH.CT scan and B-ultrasonography are the most valuable in the diagnosis of SPH.It is demanded that management of SPH depends on the histopathology and the degree of bleeding.

关 键 词：自发性肾周出血 CT诊断 B超诊断 肾切除术 根治性肾切除术 保留肾脏手术 肾动脉栓塞术 血肿穿刺引流术 

分 类 号：R692.9[医药卫生—泌尿科学]