自发性腹膜后出血的诊断与治疗(附11例报告)

The Diagnosis and Treatment of Spontaneous Retroperitoneal Hemorrhage (a Report of 11 Cases)

目的 :提高对自发性腹膜后出血的诊治水平。方法 :对 11例自发性腹膜后出血进行回顾性分析。结果 :手术及病理证实肾血管平滑肌脂肪瘤 6例 ,肾包膜恶性血管外皮细胞肉瘤 1例 ,巨大肾积水 1例 ,肾上腺血管平滑肌脂肪瘤 1例。保守治疗2例 ,其中 1例血管造影疑肾外型血管平滑肌脂肪瘤并行栓塞治疗 ,1例出血原因不明。结论 :自发性腹膜后出血常见病因为肾肿瘤 ,其中尤以良性肾血管平滑肌脂肪瘤最为多见。CT是最有价值的检查方法。根据病因及出血的程度确定治疗方法。

Objective: To improve the diagnosis approach and management algorithm for spontaneous retroperitoneal hemorrhage. Methods: 11 cases of spontaneous retroperitoneal hemorrhage during 1985-2002 were analysed retrospectively. Results: According to operative finding and pathological examination, renal angiomyolipoma was in 6, malignant hemangiopericytoma of rena capsule, hydronephrosis, and adrenal angiomyolipoma in 1, respectively. In the other 2 cases, CT Scan showed normal kidney but with huge perinephric hematoma, among that angiography and embolization was performed in 1, case with suspective diagnosis of extrarenal angiomyolipoma; the cause of bleeding in another case was unknown. Conclusion: The most common cause of the spontaneous retropritoneal hemorrhage was the renal tumor, among which angiomyolipoma being predominant. CT scan was the most valuable examination. The treatmeat was defined by the cause and the degree of hemorrhage. The patient of unknown cause could be treated conservatively and CT scan should be followed-up closely.