肾肿瘤破裂大出血并多系统器官功能不全的诊断和治疗

Diagnosis and treatment of massive hemorrhage induced by renal tumor rupture complicated with dysfunctions of multiple system organs

目的探讨肾肿瘤破裂大出血合并多系统器官功能不全的诊断和治疗。方法对15例肾肿瘤破裂大出血并多系统器官功能不全(MSOF)患者的临床诊治资料进行回顾性分析,术前快速行CT检查,积极抗休克,急诊手术,术后积极治疗MSOF,呼吸机辅助呼吸。结果行根治性肾切除术,存活93.33%(14/15),死亡6.67%(1/15)。术后存活者随访1～17年仅1例局部肿瘤复发而再次手术治疗。手术后病理为肾细胞癌8例、肾血管平滑肌脂肪瘤6例、肾动脉瘤1例。结论肾肿瘤破裂大出血为泌尿外科急症,CT可以准确显示出血程度和部位,肾肿瘤破裂大出血应行根治性肾切除,积极救治可逆转MSOF。

Objective To investigate diagnosis and treatment of massive hemorrhage induced by renal tumor rupture complicated with dysfunctions of multiple system organs.Methods The clinical data of 15 cases with massive hemorrhage induced by renal tumor rupture complicated with multiple system organs dysfunctions（MSOF） were retrospectively analyzed.All patients received rapid preoperative CT examination,positive anti-shock treatnment,emergency operation,postoperative treatment of active MSOF,assisted mechanical ventilator.Results Survival rate was 93.33%（14/15） and the mortality rate was 6.67%（1/15） after radical nephrectomy.Only 1 case needed operation treatment because of local tumor recurrence during postoperative follow-up 1-17 year for survivors.Pathology after operation included 8 cases with renal cell carcinoma,6 cases with renal angiomyolipoma,1 case with renal artery aneurysm.Conclusions Massive hemorrhage induced by the renal tumor rupture is urological emergency.CT can accurately show the degree and site of bleeding,and massive hemorrhage induced by the renal tumor rupture should be treated with radical nephrectomy,which can reverse MSOF.