自发性肾周围出血的临床诊治分析

目的 探讨自发性肾周围出血的影像学特点及诊治方法。方法 对35例自发性肾周围出血急诊患者的临床诊治及影像学特点进行回顾分析。所有病例均无外伤、抗凝治疗及肾移植史。35例全部经CT检查，10例行B型超声检查。10例行DSA检查并栓塞治疗，其中25例经手术病理证实。结果 35例自发性肾周围出血中，错构瘤18例，肾细胞癌7例，肾囊肿2例，单纯肾动脉瘤1例，肾动脉瘤破裂合并妊娠2例；嗜铬细胞瘤3例，其中2例合并妊娠。肾盂输尿管连接处狭窄1例。肝癌1例。结论 自发性肾周围出血的病因中肾脏肿瘤性病变居首位，尤以肾错构瘤多见。肾上腺肿瘤、肾血管疾病及腹腔内脏器病变也可引起腹膜后出血。CT可以准确而迅速地显示出血程度和范围。DSA检查对肾血管性疾病的诊断应属首选，同时可行动脉栓塞治疗，降低肾切除率。

Etiology, diagnosis and management of spontaneous per renal hemorrhage

Objective To investigate the etiology,diagnosis,and management of spontaneous perirenal hemorrhage(SPH).Methods The clinical data of 35 patients,10 males and 12 females,aged 35.9(12-77),with the diagnosis of SPH,without history of trauma,anticoagulant use,dialysis,and renal transplantation,were analyzed.Results The underlying disease of SPH included angiomyolipoma(18 cases),renal cell carcinoma(7 cases),kidney cyst(2 cases),renal artery aneurysm(3 cases),rupture of renal artery aneurysm accompanied with pregnancy(2 cases),renal pheochromocytoma(3 cases 2 of which accompanied with pregnancy),congenital stricture of pelviureter junction(1 case),and liver cancer(1 case).The most common underlying diseases were nephrigenic(96%) with angiomyolipoma ranking first(54%) followed by renal cell carcinoma(21%).The underlying diseases were diagnosed correctly in 23 cases(69%).CT helped in diagnosis of 34 cases.Surgery was performed on most of the cases.Conclusion The most common causes of SPH is renal neoplasms more than 50% of which are benign.Renal artery aneurysm and pheochromocytoma tend to rupture during pregnancy.CT is the first method of choice in diagnosis.