钝性肾损伤后肾动脉假性动脉瘤1例报道并文献复习

Renal artery pseudoaneurysm after blunt renal trauma:a case report and literature review

目的探讨钝性肾损伤后肾动脉假性动脉瘤(RAP)的临床特点及治疗方案。方法回顾性分析2021年12月解放军第九〇三医院诊治的1例和筛选1996—2021年期间文献报道且资料较齐全的35例钝性肾损伤后RAP患者的临床资料。全组男28例,女7例,1例未报道性别;年龄(27.0±14.4)岁。报道RAP发病时间32例,诊断时间(14.0±12.5)d。统计学方法采用独立样本t检验。结果RAP多在钝性肾损伤后14 d左右形成,最常见临床表现为肉眼血尿和腰腹痛。36例患者中31例行超选择性动脉栓塞术,5例保守治疗。除保守治疗的1例有RAP残留外,余均痊愈。保守治疗后痊愈的4例和选择动脉栓塞术治疗的31例二者间的瘤体最大径[(7.5±3.1)mm比(15.7±6.2)mm]比较差异有统计学意义(P=0.022)。结论钝性肾损伤后出现迟发性肉眼血尿或突发腰腹部疼痛应考虑RAP。增强CT和多普勒超声推荐作为首选检查,数字减影血管造影(DSA)是诊断的“金标准”。超选择性动脉栓塞术为一线治疗方案,截至目前保守治疗缺乏高等级证据支持,但在RAP最大径≤10 mm的无症状患者中可考虑选择。

Objective To investigate the clinical features and treatment of renal artery pseudoaneurysm(RAP)after blunt renal trauma.Methods The clinical data of 1 case treated in The 903rd PLA Hospital in December 2021 and 35 cases of RAP after blunt renal trauma reported in literatures from 1996 to 2021 were retrospectively analyzed.There were 28 males and 7 females in the whole cases,and the gender of 1 case was not reported;the age was(27.0±14.4)years old.The RAP onset time was reported in 32 cases,and the diagnosis time was(14.0±12.5)d.Independent sample t test was used.Results RAP mostly formed about 14 days after blunt renal injury,and the most common clinical manifestations were gross hematuria and abdominal/flank pain.Of the 36 patients,31 cases underwent superselective arterial embolization,and the other 5 cases chose conservative treatment.Except for 1 case with RAP residue after conservative treatment,the other 35 cases were recovered.There was a statistically significant difference in the maximum diameter of tumor between the 4 patients who were cured by conservative treatment and the 31 patients who were treated by arterial embolization[(7.5±3.1)mm vs.(15.7±6.2)mm](P=0.022).Conclusions RAP should be considered for delayed gross hematuria or sudden lumbar and abdominal pain after blunt renal injury.Enhanced CT and Doppler ultrasonography are recommended as the initial screening.The gold standard for diagnosis is digital subtraction angiography(DSA).Superselective arterial embolization is a first-line treatment option.So far,conservative treatment lacks high-level evidence support,but it can be considered in asymptomatic patients with a maximum diameter of RAP≤10 mm.