肾动脉瘤14例诊治报告

Diagnosis and treatment of renal artery aneurysm in fourteen cases

为探讨肾动脉瘤(RAA)的特点和诊治方法,回顾性分析2015年6月—2019年10月我院收治的14例RAA患者的临床资料。14例患者中,男8例,女6例;年龄40~77岁,平均59.1岁;左肾RAA 6例,右肾RAA 7例,双肾RAA 1例;体检发现8例,表现为腰腹部疼痛5例,表现为血压骤升1例;2例RAA破裂,1例表现为右腹部疼痛,另1例体检发现,行介入治疗后26 h出现左腹部不适,2例破裂时均伴有失血性休克;6例行肾动脉栓塞术,2例行肾动脉覆膜支架植入术,2例RAA破裂行肾切除术,4例观察随诊。本组10例治疗患者中9例一次成功,1例介入治疗后瘤体破裂行二次手术,治疗患者均康复出院。平均随访时间17(1~50)个月,5例失访,其余9例无严重并发症或死亡病例。RAA临床少见,常因体检发现,平素多无症状,确诊主要依靠CT血管造影(CTA)。对有治疗指征的患者,多采取介入治疗,而对RAA破裂伴急性失血性休克患者,需紧急手术以挽救患者生命。

The clinical data of 14 patients with renal artery aneurysm(RAA)in our hospital during the period from June 2015 to October 2019 were retrospectively analyzed to investigate the characteristics,diagnosis and treatment of RAA.The patients included 8 males and 6 females,whose age ranged from 40 to 77(mean,59.1)years old.Among these patients,6 cases were left RAA,7 cases were right RAA,and 1 case was bilateral RAAs.Eight patients were found by physical examination.Related symptoms including abdominal pain was found in 5 patients and sudden increase in blood pressure was found in 1 patient.Two patients were found RAA rupture.One had pain in the right abdomen,the other was found by physical examination and revealed a left abdominal discomfort 26 h after intervention therapy.Both of them were accompanied by hemorrhagic shock when the tumor was ruptured.Six cases received renal artery embolization,2 cases received renal artery stent graft implantation,2 patients with RAA rupture were admitted for nephrectomy,the remaining 4 patients required observation and follow-up.The treatment of RAA succeed at the first operation in 9 of 10 patients.One case underwent secondary surgery for tumor rupture after interventional treatment.All treated patients recovered well and discharged.During the average followed-up period of 17(range,1-50)months,5 patients were lost in follow-up and the remaining 9 cases had no serious complications or deaths.RAA is a rare disease,and mostly found through physical examination.Patients usually have no symptoms,so the diagnosis mainly depends on CT angiography(CTA).For patients with treatment indications,interventional therapy is usually adopted,while for patients with renal aneurysm rupture and acute hemorrhagic shock,we often perform nephrectomy to save their lives.