肾部分切除术后迟发性出血原因分析及防治

目的 探讨肾部分切除术后迟发性出血原因及其防治方法.方法 1998-2007年行肾部分切除术382例,发生迟发性出血5例(1.3%).男4例,女1例.平均年龄51(42～63)岁.原发病均为肾癌,肿瘤平均直径2.8(2.3～4.2)cm.2例肿瘤直径＞3.0 cm者手术时阻断肾蒂,3例肿瘤直径＜3.0 cm者游离肾脏后以手握控制肾脏出血;切除范围距离肿瘤边缘0.5～1.0 cm正常肾实质,肾创面"8"字或"U"形对合缝合.5例术后出血时间为6 d～3个月;出血量平均2300(1000～4500)ml.患者均表现为反复肉眼血尿伴患侧腰背部胀痛不适,伴休克表现3例,接受输血治疗3例.5例患者肾动脉造影发现出血原因均为创面肾动脉分支残端形成假性动脉瘤.其中3级肾动脉分支出血4例,4级肾动脉分支出血1例.结果 1例再次手术行患肾切除术,4例行经皮选择性肾动脉栓塞治疗.5例术后出血皆停止.未发生高血压、尿瘘等并发症.4例随访2～9年,肿瘤无复发,未再出血.结果 肾部分切除术后迟发性出血原因包括切面肾动脉小分支未结扎或部分结扎,缝合肾脏创面时缝针贯穿肾实质内动脉等.一旦出现此并发症,需要及时治疗,经皮选择性肾动脉栓塞是有效的治疗方法.

Delayed hemorrhage after partial nephrectomy: 5 cases report

Objective To discuss the etiology and management of hemorrhage after partial nephrectomy because of renal cancer. Methods Of the 382 cases performed partial nephrectomy during a 10-year period, 5 patients(1.3%) had postoperative hemorrhage because of a renal artery pseudoaneurysm. The ages of these patients were from 42 to 63 years. All the tumors were malignant with an average diameter of 2. 8 cm. The renal pedicle was blocked in 2 cases with tumor size larger than 3 cm. The kidney was reconstructed with interrupted 0 chromic sutures in "8"or "U" style. Delayed postoperative hemorrhage occurred from 6 days to 3 months. The blood loss was from 1000 to 4500mi. Shock or lower blood pressure occurred in 3 patients. Nephrectomy was performed in 1 patient and selective angiographic embolization was performed in other 4 cases. Results Angiography revealed renal artery pseudoaneurysm in all 5 cases at the third (4 cases) or fourth branch(1 patient).Percutaneous embolization was successful in 4 patients. Four cases were followed up for 2 to 9 years without complication. Conclusions Delayed postoperative hemorrhage following partial nephrectomy is an uncommon but potentially life-threatening complication. Super-selective angiographic embolization could be the first choice of treatment.