自发性肾包膜下血肿的影像特征与治疗方法选择

Diagnosis and treatment of spontaneous renal subcapsular hemorrhage (Report of 20 cases)

目的:探讨自发性肾包膜下血肿的诊治方法。方法:对20 例自发性肾包膜下血肿临床资料进行回顾性分析。结果:20例中,行肾切除术6例、根治性肾切除2例、保留肾脏手术1例,血肿穿刺引流6例,肾动脉栓塞术1例,保守治疗4例。痊愈13例,未见血肿复发;死亡4例;失访3例。结论:自发性肾包膜下血肿多见于肾肿瘤,治疗取决于出血的严重程度和原发病。

Objective:To study the diagnosis and treatment of spontaneous renal subcapsular hemorrhage.Methods:The clinical data of 20 cases were reviewed retrospectively in our hospital between 1991 and 2003. In the 20 cases, flank pain, upper abdomen pain, nausea and vomitus, febrile, flank mass, gross hematuria, radiating pain, edema of both lower extremity occurred in 20, 15,11,9,8,4,3 and 1 cases, respectively. The final diagnosis was established on B-ultrasonography, CT and DSA in 15, 14 and 1 cases, respectively. Results:In 20 cases, nephrectomy were performed in 6, radical nephrectomy in 2, nephron spare surgery in 1 case, inspiration and drainage of hemorrage in 6, renal artery embolization in 1 case and careful watching in 4 cases. The most common cause was of neoplastic origin (6 angiomyolipomas and 1 renal cell carcinoma). Other unusual cases included renal cyst (1 case), hydronephrosis(1 case), choriocarcinoma (1 case), infectious diseases(1 case). Thirteen of 20 cases were cured, four died for renal tumor and/or renal function failure. Conclusions:The tumor of kidney was the most common cause of this disease. B-ultrasonography and CT are the most valuable in the diagnosis. It demanded that management of spontaneous renal subcapsular hemorrhage depended on the histopathology and the degree of bleeding.