自发性肾包膜下和肾周血肿的诊断与治疗

目的 提高对自发性肾包膜下和肾周血肿的诊断与治疗水平。方法 对17例自发性肾包膜下和肾周血肿病例的临床及随访资料进行回顾性分析,诊断采用B超、CT和血管造影等影像学检查手段。17例中,肾切除手术13例,肾活检术1例,其余保守治疗。结果 随访6－108个月,死亡3例,其余均健在。结论 影像学是诊断本病的重要手段,CT最有诊断价值。治疗方法应根据病因决定,多数以手术为主。     

肾穿刺造瘘和尿激酶注射联合治疗体外冲击波碎石后肾包膜下血肿

目的：探讨肾穿刺造瘘和尿激酶局部注射治疗体外冲击波碎石(ESWL)后肾包膜下血肿的价值。方法：对ESWL后肾包膜下巨大血肿患者2例，在B超定位下行肾包膜下血肿穿刺造瘘术．引流出陈旧性出血后，每隔3～4d间断向血肿内注入尿激酶20～50万IU并保留24h．然后充分引流。结果：穿刺造瘘后的第1～4天内引流出陈旧性积血51～98m1，注入尿激酶溶解血凝块。1个月后血肿体积约为治疗前的1／35～1／15。经14～18个月随访。无继发出血、感染、高血压等并发症。结论：对ESWL后肾包膜下巨大血肿患者行穿刺造瘘置管引流术，同时局部应用尿激酶溶解血凝块，可有效溶解引流肾包膜下陈旧性出血和血凝块，获得理想的疗效。     

自发性肾脏破裂出血18例

目的 提高对自发性肾脏破裂出血的诊治水平。方法 回顾分析18例自发性肾脏破裂出血患的临床资料。结果 肾包膜下出血10例，肾周血肿8例。其中错构瘤10例，保守治疗3例，肾切除2例，肿瘤剜除术5例；囊肿3例，保守治疗2例，探查血肿清除1例；移植肾破裂2例，均行移植肾切除；肾癌1例，行根治性肾切除；无明显原因2例，1例保守治疗，1例行血肿清除。结论 自发性肾脏破裂出血的治疗取决于原发病的性质及出血的严重程度。     

肾错构瘤自发性破裂10例报告

目的：探讨肾错构瘤自发性破裂出血的诊断与治疗。方法：10例肾错构瘤自发性破裂的患者。均行B超检查，9例行CT或MRI检查。结果：8例术前CT或MRI提示为肾错构瘤破裂出血，1例MRI诊断为肾肿瘤破裂出血，1例B超诊断为肾占位病变并肾周血肿。所有患者肿瘤直径均大于6cm，9例行患侧肾切除术。结论：CT和MRI是诊断肾错构瘤破裂出血的较好方法，并能提示病变的性质以及确定出血的范围。对于肿瘤直径大于4cm，且靠近肾包膜生长的肾错构瘤应积极治疗，手术治疗时应尽量保留有功能的肾组织。     

创伤性肾包膜下血肿的微创治疗(附8例报告)

目的:探讨经皮穿刺引流和尿激酶局部注射治疗创伤性肾包膜下血肿的价值。方法:闭合性肾损伤并发肾包膜下巨大血肿患者8例,出血停止1~3周后,在B超定位下行经皮血肿穿刺引流术,引流出陈旧性出血后,每隔3~4天向血肿内注入50~20万U尿激酶并保留24h,然后充分引流。结果:穿刺引流后3~4天引流出陈旧性积血(81±32)ml。间断注射尿激酶溶解血凝块, 20~35天后,血肿体积约为治疗前的1 /15 ~1 /50。经12 ~34个月随访,无继发性出血、感染、高血压等并发症。结论:对闭合性肾损伤肾包膜下巨大血肿患者行经皮血肿穿刺引流术,同时局部应用尿激酶溶解血凝块,可有效溶解引流肾包膜下陈旧性出血和血凝块,具有推广价值。     

输尿管镜碎石术后肾包膜下血肿危险因素分析

目的：探讨输尿管镜碎石术后发生肾包膜下血肿的危险因素。方法：回顾性分析2006年7月～2008年12月行输尿管镜碎石术后发生肾包膜下血肿3例患者的病例资料，评估其术前、术中可能存在的导致肾包膜下血肿发生的风险因素。结果：2例行双侧输尿管镜碎石术，1例行单侧输尿管镜碎石术，手术均顺利，但均发生肾包膜下血肿，其中1例术前并有高血压、糖尿病、尿路感染，发生双侧肾包膜下血肿并失血性休克；1例老年男性术前无其他并发症，术后术侧腰部出现皮下瘀斑，B超发现肾包膜下血肿；另1例术前并发高血压、糖尿病，行双侧输尿管镜碎石术，术后发生单侧肾包膜下血肿。结论：肾包膜下血肿是输尿管镜碎石术的一个严重并发症，高血压、糖尿病、高龄、尿路感染是其发生的危险因素，而手术本身导致的肾盂内压力改变是其发生的诱发因素。     

经皮肾镜术后肾包膜下巨大血肿的治疗（附16例报告）

目的：探讨经皮穿刺置管引流和尿激酶局部注射治疗经皮肾镜术后肾包膜下巨大血肿的价值。方法：经皮肾镜术后形成肾包膜下巨大血肿16例,出血停止1～3周后,在B超定位下行经皮血肿穿刺置管引流术,引流出陈旧性积血后,每间隔2～3d,通过引流管分别向血肿内注射3万U的尿激酶并保留24h,然后充分引流。结果：经皮穿刺置管引流陈旧性积血后,间断注射尿激酶溶解血块,30~35天后复查CT显示血肿明显减小,仅为治疗前的1／19～1／56。16例患者经1～2年随访,无继发性出血、感染、高血压等并发症。结论：对经皮肾镜术后肾包膜下巨大血肿患者行经皮血肿穿刺置管引流,同时应用尿激酶局部注射溶解血凝块,可有效溶解引流。肾包膜陈旧性出血和血凝块,具有推广价值。     

标准通道经皮肾镜术后肾包膜下积液或血肿的临床研究

目的探讨经皮肾镜术后症状性肾包膜下积液或血肿的治疗方法及结果。方法回顾性分析2014年1月至2016年11月对286例行经皮肾镜术治疗上尿路结石患者的临床资料,共有13例患者术后出现症状性肾包膜下积液或肾包膜下血肿,均采取局麻下B超引导肾包膜下积液或血肿肾镜穿刺套装穿刺引流方法进行治疗。结果 13例患者均成功治愈。结论经皮肾包膜下积液穿刺引流对症状性肾包膜下积液或血肿可取得治愈效果。     

ESWL致肾包膜下、肾周围血肿12例分析及对策

目的：降低ESWL致肾包膜下、肾周围血肿的发生率.方法：回顾1999～2009年肾结石ESWL后致肾包膜下、肾周围血肿12例的病史资料,分析总结与之密切相关的临床危险因素和术中技术参数.结果：12例肾包膜下、肾周围血肿经积极对症治疗后,9～18个月血肿均消失.高血压、高龄男性、肾下盏结石是重要的临床危险因素,高脉冲能量、多脉冲次数、高脉冲频率是致病的主要技术参数.结论：高血压、高龄男性、肾下盏结石患者术前应良好控制高血压、术中适当降低脉冲能量、合理减少脉冲次数、适当控制脉冲频率是降低ESWL致肾包膜下、肾周围血肿的重要对策.     

肾包膜下血肿:诊断和治疗的一个难题

本文作者报告了14例高血压患者罹患了肾包膜下血肿,其年龄为17至66岁,平均年龄35.8岁,肾包膜下血肿左侧6例,右侧8例,两侧发病率几乎相等。男性12例,女性2例,差不多新近均有高血压或原有高血压加剧。11例有腰痛,3例有肉眼血尿并能触及腰部有肿块。8例有肾外伤史如肾穿刺活检等作为诱因。1例给了抗凝治疗,1例抗凝治疗剂量过量,1例为肾肿瘤,4例为特发性无诱因可查。     

自发性肾周出血的诊治(附31例报告)

目的 探讨自发性肾周出血(SPH)的诊治方法。方法 对31例SPH临床资料进行回顾性分析。男13例，女18例，平均年龄42岁。左侧17例，右侧14例。腰背部疼痛31例，腰腹部包块10例，休克8例，血尿、腹腔出血各3例。CT诊断18例(18／19)、B超诊断22例(22／29)、KUB加IVU诊断7例(7／14)。结果 31例患者中，行肾切除术18例、根治性肾切除术1例、保留肾脏手术4例、肾动脉栓塞术2例、血肿穿刺引流1例、保守治疗5例。病理诊断肾血管平滑肌脂肪瘤ll例、肾囊肿6例、肾癌4例、肾感染3例、肾动脉瘤和肾积水各2例。28例痊愈出院，3例术后血液透析治疗。结论 SPH临床症状取决于出血程度和持续时间，主要表现为上腹部疼痛，以肾血管平滑肌脂肪瘤破裂多见。CT和B超是诊断SPH的首选方法，治疗方案应根据不同病因和出血情况确定。     

肾包膜下积尿的发生原因与处理

目的探讨肾包膜下积尿的病因与处理方法。方法报告12例肾包膜下积尿患者的临床资料。均经影像学诊断,7例为梗阻性积尿,3例为漏尿性,2例病因不明。首先均行经皮肾穿刺引流术。放弃治疗1例;单纯穿刺引流2例;留置双J管内引流2例,1例改行肾裂口修补术;体外冲击波碎石术3例;肾盂输尿管成形术2例;肾输尿管切除术和大网膜包裹肾脏内引流术各1例。结果10例痊愈出院,2例死于肾外恶性肿瘤。结论肾包膜下积尿病因以梗阻性为多见。CT检查有助于确定积尿范围及作病因诊断。及时行肾包膜下穿刺引流为首要的治疗选择,同时针对病因作进一步治疗。     

Renal angiomyolipoma: report of 2 cases of tuberous sclerosis in female siblings

Two cases of renal angiomyolipomas in female siblings associated with tuberous sclerosis were reported. The first case was a 47-year-old housewife who visited the hospital because of severe right flank pain. Bilateral renal angiomyolipomas and hemorrhage in the right angiomyolipoma were recognized by computerized tomography, ultrasonography and renal angiography. After 2 months she had another episode of left flank pain and was diagnosed to have hemorrhage in the left renal tumor. The pain remissed by conservative treatment. Bilateral nephrectomy and hemodialysis would be necessary if she were to have a third attack. The second case was her 36-year-old sister with the chief complaint of left flank pain and genital bleeding. CT and renal angiography suggested a large angiomyolipoma in her left kidney and a small one in her right kidney. Left nephrectomy, right partial nephrectomy and hysterectomy were performed to prevent intratumoral hemorrhage. The histopathological diagnosis was angiomyolipoma of kidneys, uterus and lymphnodes of right renal hilus. Although pre-operative differentiation of angiomyolipoma from renal cell carcinoma has been difficult, recently diagnosis has become possible by CT, ultra-sonography and angiography.     

Renal lymphoma. Report of 2 cases and review of the literature]

Two cases of renal lymphoma were reported. Case 1 was a 73-year-old, and case 2 was a 59-year-old female. Their chief complaint was flank pain. The findings obtained by CT and angiography were not compatible with renal cancer. The tentative diagnosis of case 1 was inflammatory disease or soft tissue tumor, and that of case 2 was renal subcapsular tumor. Histological specimen was obtained by open biopsy from case 1, and by nephrectomy from case 2. Immunohistochemical surface marker study revealed both tumors were B cell lymphoma. Chemotherapy (CHOP-Bleo, or PPA) in both cases and additional radiotherapy in case 2 markedly reduced the tumor size. Nevertheless, case 1 died 5 months later from recurrence, and case 2 died 14 months later of gastrointestinal bleeding. At autopsy, the renal subcapsular layer was infiltrated by lymphoma cells in both cases, and lymphadenopathy was not observed. Reviewing 16 cases previously reported as renal lymphoma, the capsular or subcapsular diffuse infiltration to the kidney is considered to be a characteristic feature of renal lymphoma.     

小肾癌25例的诊治体会

目的 探讨直径小于4cm的小肾癌的诊治效果。方法 对25例直径小于4cm的小肾癌的诊治进行回顾性总结。结果 25例均行B超、CT检查，B超明确诊断16例，准确率64％(16／25)；CT明确22例，准确率88％(22／25)。16例行根治性肾切除术，9例行保留肾单位手术。随访10-102个月，平均56．6个月。9例行保留肾单位手术中，发生术后出血1例，局部复发1例。结论 小肾癌的诊断主要依据B超、CT等影像学检查综合分析作出，其中CT是最有价值的检查万法。根治性肾切除术治疗小肾癌疗效可靠、安全，仍是首选手术方式。     

肾海绵状血管瘤的诊断和治疗（附3例报告）

目的：探讨肾海绵状血管瘤的诊断与治疗。方法：回顾性分析3例肾海绵状血管瘤患者,男2例,女1例,年龄17-34岁。临床表现包括腰痛1例,肉眼血尿1例,腰痛并镜下血尿1例。多普勒超声和CT扫描显示肾脏肿块,2例体积较大,其中1例伴有肾静脉血栓形成。2例男性患者行肾切除,1例女性患者行肿块切除。结果：3例患者术后血尿,腰痛均消失。术后随访6个月-2年,无复发或并发症,复查CT和尿液检查未见异常。结论：肾海绵状血管瘤是一种罕见的良性病变,其症状主要为腰痛、血尿。肾海绵状血管瘤少有术前诊断,多为术后病检证实,CT、B超、MRI和肾血管造影均有诊断价值,但不能完全与恶性肿瘤区分。手术治疗是主要的治疗方法。     

肾血管平滑肌脂肪瘤12例临床分析

报告１２例肾血管平滑肌脂肪瘤，１２例均行Ｂ超检查，８例行ＩＶＵ检查，３例行肾动脉造影，９例行ＣＴ检查，１２例中手术治疗１０例（１１侧肾脏）术后均经病理检查诊断为肾血管平滑肌脂肪瘤，其中１例恶变，２例肿瘤小未予手术，１２例健康复出院，随访６个月～８年，２例分别于术后３年和７年发现对侧肾肿瘤，恶变的１例未见复发和转移，未行手术的２例瘤体未见明显变化，认为肾动脉造影，Ｂ超，ＣＴ对诊断本病具有特异性，但肿     

Spontaneous perirenal hemorrhage: a 10-year experience at our institution

OBJECTIVE: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. MATERIAL AND PATIENTS: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. RESULTS: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. CONCLUSIONS: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.     

A case of spontaneous rupture of renal cell carcinoma

A case of spontaneous rupture of renal cell carcinoma is reported. A 53-year old man was admitted with the chief complaint of sudden gross hematuria and right flank pain on December 28, 1979. On the following day, the clinical impression was right ruptured kidney, and therefore right nephrectomy was done. Pathological diagnosis was renal cell carcinoma. He received the post-operative irradiation of a total of 5,000 rads. He was seen five years later, at which time there was no evidence of local recurrence or distant metastasis of cancer. Thirty three cases of spontaneous rupture of renal cell carcinoma were collected from Japanese and English literature. Most common chief complaint is abdominal or flank pain. Excretory urography, ultrasonography, CT scan and angiography are useful, but it is difficult to diagnose preoperatively when the tumor is small. Therefore, it is important to suspect occult cancer when a reasonable cause of rupture is undetermined. In these indeterminate cases primary nephrectomy should be considered strongly.