自发性肾破裂出血的诊治分析

发布时间：2018-06-22 14:13

本文选题：自发性 + 肾破裂　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：通过对自发性肾破裂的病因、诊断及治疗的分析，探讨提高自发性肾破裂出血的诊治效果。方法：回顾性分析2011年6月—2013年12月期间我院泌尿外科收治的23例自发性肾破裂出血患者的临床资料，所有患者均行超声及CT检查，2例患者行选择性肾动脉造影检查，21例患者行排泄性尿路造影（IVU）检查。3例患者行肾切除术，7例患者行根治性肾切除术，6例患者行保留肾单位手术（NSS），2例患者行选择性肾动脉栓塞术（TAE），1例出血原因不明的患者给予血肿引流术，1例患者给予行输尿管镜碎石取石术，3例患者给予保守治疗。结果：本组23例患者均获随访，随访时间6～24个月，，其中1例患者于根治性肾切除术后18个月死于肾癌肺转移，其余患者均健在。12例肾错构瘤患者术后恢复良好，术后复查均未见肿瘤复发。2例肾囊肿患者恢复良好。2例肾动脉栓塞患者术后随访见肿瘤明显缩小。1例输尿管结石患者术后恢复良好，术后4周拔出输尿管支架管，定期复查超声，肾周积液逐渐吸收。1例病因不明患者未再次发生自发性肾破裂出血，定期复查CT亦未见肿瘤生长。结论： 1.自发性肾破裂出血的主要病因是肾肿瘤，其中以良性肿瘤多见，但应警惕恶性肿瘤的可能。 2.超声和CT在自发性肾破裂出血的诊断中起到重要作用，术中快速病理是鉴别肿瘤良恶性的最可靠方法。 3.自发性肾破裂出血的治疗主要根据原发病及出血情况，治疗方法以手术治疗为主，应尽量保留有功能的肾组织。
[Abstract]:Objective: to analyze the etiology, diagnosis and treatment of spontaneous renal rupture and to improve the diagnosis and treatment of spontaneous renal rupture. Methods: the clinical data of 23 patients with spontaneous renal rupture and hemorrhage from June 2011 to December 2013 were retrospectively analyzed. All patients underwent ultrasonography and CT examination. 2 patients underwent selective renal arteriography. 21 patients underwent excretory urography (IVU). 3 patients underwent nephrectomy and 7 patients underwent radical nephrectomy. 6 patients underwent radical nephrectomy. Two patients with renal unit operation (NSS) were treated with selective renal artery embolization (Tae). One patient with unknown bleeding reason was treated with hematoma drainage. One patient received ureteroscopic lithotripsy and 3 patients received conservative treatment. Results: all the 23 patients were followed up for 6 ~ 24 months. One patient died of lung metastasis after radical nephrectomy. The rest patients were alive and well. 12 patients with renal hamartoma recovered well after operation. No recurrence of tumor was found in 2 cases of renal cysts. 2 cases of renal artery embolism were followed up. 1 cases of ureteral calculi recovered well after operation, and 4 weeks after operation, ureteral stents were pulled out. After regular examination of ultrasound, perirenal effusion gradually absorbed 1 cases with unknown etiology. No recurrent spontaneous renal rupture and hemorrhage occurred in the patients, and no tumor growth was found in CT regularly. Conclusion: 1. The main cause of spontaneous renal rupture and hemorrhage is renal tumor, among which benign tumor is more common, but the possibility of malignant tumor should be warned. 2. Ultrasound and CT play an important role in the diagnosis of spontaneous renal rupture and hemorrhage. Intraoperative rapid pathology is the most reliable method for differentiating benign and malignant tumors. The treatment of spontaneous renal rupture and hemorrhage is mainly based on the primary disease and bleeding, the main treatment method is surgical treatment, and the functional renal tissue should be preserved as far as possible.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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