自发性肾包膜下血肿临床分析

目的探讨自发性肾包膜下血肿的发生原因,总结其临床特点及诊疗体会。方法本组6例自发性肾包膜下血肿患者通过CT和B超检查明确诊断。根据肾包膜下血肿严重程度和合并肾脏病变情况分别选择非手术治疗、经皮肾穿刺引流术和手术探查。结果 6例患者中有2例肾包膜下血肿严重且合并有肾脏占位性病变者进行手术探查,并实施患肾切除术,术后证实为血管平滑肌脂肪瘤出血。有2例血肿较轻者行非手术治疗,有2例血肿较重者行经皮肾穿刺引流术,这4例患者均痊愈出院,无肾萎缩、肾性高血压、肾积水和肾脏感染的发生。结论自发性肾包膜下血肿多由于患肾合并有其他肾脏疾病,CT和B超检查是诊断肾包膜下血肿并明确血肿严重程度的主要检查方法 ,同时明确肾脏合并疾病的诊断。根据肾包膜下血肿的严重程度分别选择非手术治疗和经皮肾穿刺引流术可取得良好治疗效果,急诊手术增加失肾率甚至危及生命,应严格掌握手术探查指征。

Diagnosis and management of traumatic subcapsular renal hematoma

Objective To investigate the causes and summarize the clinical characteristics and tactics of diagnosis and treatment of spontaneous subcapsular renal hematoma.Methods Six cases of spontaneous subcapsular renal hematoma was treated respectively with expectant,minimally invasive and operative exploration methods according to the findings of CT and ultrasonic examination.Results Two patients,who were administered operative exploration,underwent nephrectomy due to subcapsular renal hematoma,serious renal wound and renal tumour.The other four ones including two with expectant therapy and two with minimally invasive therapy were good in prognosis without renal atrophy,renal hypertension,hydronephrosis and renal infection.Conclusion Spontaneous subcapsular renal hematoma is always complicated with other renal diseases in the traumatic kidney.CT and ultrasonic examination is the major means to dectet renal hematoma and other renal diseases,and determine severity.It is suggested that expectant or minimally invasive approach be applied to the treatment according to the severity of subcapsular renal hematoma.The indications for operative exploration should be strictly judged.