肾部分切除术后出血的危险因素分析及治疗

目的探讨肾部分切除术后出血的危险因素以及相关治疗。 方法收集2005年1月至2013年12月间肾部分切除术后出血的患者，其中开放性肾部分切除术后5例，腹腔镜下肾部分切除术后2例。将其与未出血患者比较探讨肾部分切除术后出血的危险因素。 结果7例患者出血表现为术后6～22 d（平均14．9 d）内出现大量肉眼血尿，血红蛋白平均下降28．7 g／L。单因素分析发现肿瘤大小（34 cm）是肾部切术后出血的危险因素。7例出血患者均行超选择性。肾动脉栓塞术，肾动脉造影提示6例为假性动脉瘤，1例为动静脉瘘，造影及栓塞过程顺利，血尿消失。随访10～38个月，未见肾出血再发、肾功能异常以及肾萎缩。结论 肾部分切除术后出血往往为迟发性，其中肿瘤大小是术后出血的一个危险因素。超选择性肾动脉栓塞是治疗肾部分切除术后出血安全有效的治疗方法，值得临床推广应用。

Risk factors and treatment of hemorrhage after partial nephrectomy

Objective To explore the risk factors of renal hemorrhage following partial nephrectomy and its treatment. Methods From January 2005 to December 2013, a total of 7 patients with renal hemorrhage after partial nephrectomy （five open and two laparoscopic surgery） were enrolled. Data on these 7 patients were compared with those without renal hemorrhage on univariate analysis. Results Seven patients appeared a lot of naked eye hematuria at 6 to 22 d after partial nephrectomy （a mean interval of 14.9 days）, and the mean hemoglobin loss was 28.7 g/L. Univariate analysis revealed that the hemorrhage after partial nephrectomy. All the embolization, and angiography demonstrated six tumor size （≥4 cm） was a risk factor of renal patients underwent super-selective renal arterial pseudoaneurysm and one arteriovenous fistula. The angiography and embolization were successfully accomplished in all the patients, and the hemorrhage disappeared soon after the embolization treatment. During 10 to 38 months at follow- up, recurrent hemorrhage, renal function impairment and kidney shrinkage were not noted. Conclusions The renal hemorrhage after partial nephrectomy is often delayed, and the tumor size （≥4 cm） is related to the incidence of renal hemorrhage. Super-selective renal arterial embolization is a safe and effective treatment for the patients with renal hemorrhage after partial nephrectomy.