【摘要】 目的研究肾部分切除术后迟发性出血的发生率及选择性肾动脉栓塞在其中的应用。分析发生术后假性动脉瘤可能的高危因素。方法回顾性分析我科2000年1月至2010年12月426例保留肾单位手术的临床资料,比较其中14例迟发性出血患者与总体患者的手术方式、肿瘤大小、位置、在肾实质内的深度和是否单侧多发等可能的影响因素。结果 14例患者中,12例通过肾血管造影明确诊断假性动脉瘤,其中的10例(83.3%)栓塞治疗成功,另1例开放手术止血,还有1例肾切除。2例造影未见异常,通过输液支持、止血治疗后缓解。在两组患者之间,肿瘤的大小、位置以及肿瘤是否单侧多发等因素存在显著性差异。结论肾部分切除术后假性动脉瘤发生率较低,病灶直径较大、肿瘤靠近肾蒂和同侧多发病灶是其危险因素。选择性肾动脉栓塞可以安全有效的治愈大多数此类患者,可作为首选治疗。更多还原

【Abstract】 Objectives We aimed to evaluate the occurrence rate of partial nephrectomy derived delayed renal hemorrhage and its treatment using selective renal arterial embolization,and to analyze the risk factors for the incidence of post- surgical pseudoaneurysm. Methods We retrospectively analyzed the clinical data of 426 patients treated with nephron- sparing surgery in our department between January 2000 and December 2010. 14 of the 426 patients suffered from delayed renal hemorrhage. We compared the surgical approach,tumor size and location,tumor depth in the renal parenchyma,and the occurrence of unilateral multiple tumor between the 14 patients with delayed renal hemorrhage and the overall 426 patients. Results Pseudoaneurysm was diagnosed by renal angiography in 12 out of the 14 patients with delayed renal hemorrhage. Of the 12 patients,10( 83. 3%)were successfully cured using selective renal arterial embolization,1 was treated with open surgery,and the other 1 was treated with nephrectomy. For the 2 out of 14 patients that were without pseudoaneurysm,the symptom of hemorrhage was relieved by transfusion and hemostasis. We found that the size,and location of the tumor,and the unilateral multiple tumors were significantly different between the 14 patients and the total 426 patients.Conclusions Post- surgical pseudoaneurysm showed a low incidence. The risk factors for pseudoaneurysm include lesion with large diameter,tumor near the renal pedicle,and unilateral multiple tumors. Most patients with pseudoaneurysm were successfully cured by selective renal arterial embolization. Therefore,selective renal arterial embolization can be used as the preferential therapy for pseudoaneurysm.更多还原