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Objective To evaluate the value of diagnosis and treatment of selective renal arteriography and embolization for renal hemorrhage.
目的 评价选择性肾动脉造影诊断和栓塞治疗肾出血的临床价值。
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Methods: Selective renal artery embolization was performed in 68 patients via femoral artery with Seldinger technique, 30 cases were embolized with gelatin sponge chips before operation for renal carcinoma, and 8 cases were embolized with MMC and iodized oil, and gelatin sponge for palliative treatment of advanced renal carcinoma, 6 cases were embolized with thread segments for symptomatic renal angiomyolipoma, 24 cases were embolized with self blood coagulum, gelatin sponge and/or steel coils for traumatic renal hemorrhage.
采用改良Seldinger技术经皮股动脉穿刺插管，对68例进行选择性肾动脉栓塞治疗，其中30例为肾癌术前辅助治疗，应用明胶海绵颗粒栓塞；8例为晚期肾癌姑息性治疗，采用丝裂霉素＋碘油的乳剂行末梢栓塞，然后用明胶海绵行肾动脉主干栓塞；6例症状性肾血管平滑肌脂肪瘤，采用真丝线段栓塞；24例肾创伤出血，采用自身血块、明胶海绵或弹簧钢圈栓塞。
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And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%、27.39%、20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54,low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively. Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding.
结果：①术后一过性发热62例(84.9%)，腹痛腹胀48例(65.8%)是介入断流术常见的并发症，未发生严重并发症；②门静脉造影显示胃冠状静脉、胃短静脉和胃后静脉的曲张分流的出现率是100%、65.26%和38.34%；显示食管静脉曲张主要由胃冠状静脉供血，胃静脉曲张主要由胃短静脉和胃后静脉供血；胃冠状静脉大多数为单支，少数为双支，其双支的出现率分别为30.57%；胃冠状静脉开口于门静脉主干的为52.06%，开口于脾静脉主干的为27.39%和开口于门脾静脉交汇处的为20.55%；③发现胃肾分流3例，脾肾分流7例、腹膜后门腔静脉分流2例，以及CTA检查发现脐静脉开放者2例；④73例患者介入断流术前和术后平均自由门静脉压力分别为3.87±1.82kpa和3.64±1.14kpa，前后比较存在显著性差异；11例再次介入手术患者的术前、术后和复发后的自由门静脉压力分别为4.02±0.24kpa、3.82±0.25kpa和3.93±0.23kpa ，前后比较发现首次术前与术后存在显著性差异，首次术前和复发出血术前门静脉压力比较无显著性差异；⑤介入术后复查曲张静脉转归基本消失54例，轻度19例；⑥Spearman相关分析和Logistic多因素回归分析，肝功能分级、静脉曲张程度、门脉血流方向和残存小侧支四个因素对曲张静脉转归有影响；Spearman相关分析和Logistic多因素回归分析门脉高压性胃病和出血量等因素对复发出血时间有影响；⑦COX回归分析，门体分流和曲张静脉转归两个因素对术后生存有影响；⑧术后随访6-70月，1、2、3、4、5年的累计复发出血率和累计生存率分别为17.81%、28.77%、38.36%、43.84%、47.95%和93.15%、91.78%、86.30%、83.56%、80.82%；结论：介入断流术治疗门脉高压食管胃底静脉曲张有独特的优点，可以快速直接控制曲张静脉出血而门静脉压力无显著增高，保证了肝脏灌注；与外科分流术相比适应证广、损伤轻、术后恢复快，不易遗漏曲张静脉；肝功能分级、曲张静脉程度、门脉血流方向和残存侧支血管对食管胃曲张静脉转归有影响；门脉高压性胃病对复发出血时间有影响；门体分流和曲张静脉转归对生存时间有影响。
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Results:Based on CT manifestation,the renal trauma can divided into 4 types :(1)rupture of kidney 26 cases,(2) subcapsular hematoma 19 cases,(3) cases,(4)single hematoma around the kidney 2 cases.
结果：依据CT表现将肾夕伤分为4型：（1）肾挫伤26例；（2）肾包膜下出血19例：（3）严重肾损伤13例；（4）单纯肾周血肿2例。
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Methods: Between November 2003 and December 2005, 67 patients with renal cell carcinoma underwent retroperitoneal laparoscopic radical nephrectomy (34 patients, group A) and open radical nephrectomy (33 patients, group B). Operating time, blond loss, amount of postoperative drainage, time to ambulation, recovery of intestinal function after operation, the postoperative hospital stay, use of antalgesic and transfusion blood and plasma were compared between group A and group B, retrospectively. Results: In group A, the operations of 31 patients were successful and 3 cases failed, then conversed to open surgery. Firstly, one case were not decented the prerenal fascia and the other two cases occurred complications, one case was due to injurying genital gland vein, with blood loss of 500m1, another fatty renal capsula was too thick to explose the renal pedicle. The operations of group B were all successful, only one case was died of intracerebral hemorrhage after two monthes.
回顾性分析和比较后腹腔镜肾癌根治性切除术(Retroperitoneal laparoscopic radical nephrectomy， RLRN)34例与开放性肾癌根治性切除术(Open radical nephrectomy， ORN)33例，比较两种方法的手术时间、术中出血、术后引流、术后最早下床活动时间、肠功能恢复情况、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量、术后随访时间及手术效果结果：A组中1例因最初对解剖结构难于辨认，无法分离肾前筋膜至肾门而改行开放手术，1例因损伤精索静脉出血难以控制而改行开放手术，1例因肾周脂肪过多，无法将肾脏掀起显露肾蒂而行开放手术，31例手术成功。B组手术均获成功，1例术后2个月因大面积脑出血死亡，余均无瘤生存。
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Results 7of22cases were angiomyolipoma,6were xanthogranulomatous pyelonephritis,4were multilocular cystic nephroˉma,2were leiomyoma of kidney,2were renal abscess,one case were renal fibrolipoma.
结果 误诊为肾癌的良性占位病变22例，其中肾血管平滑肌脂肪瘤合并出血7例，局灶型黄色肉芽肿性肾盂肾炎6例，肾多发性囊性肾瘤4例，肾平滑肌瘤2例，肾脓肿2例，肾纤维脂肪瘤1例。
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Results 7of22cases were angiomyolipoma,6were xanthogranulomatous pyelonephritis,4were multilocular cystic nephroˉma,2were leiomyoma of kidney,2were renal abscess,one case were renal fibrolipoma.
结果 误诊为肾癌的良性占位病变22例，其中肾血管平滑肌脂肪瘤合并出血7例，局灶型黄色肉芽肿性肾盂肾炎6例，肾发性囊性肾瘤4例，肾平滑肌瘤2例，肾脓肿2例，肾纤维脂肪瘤1例。
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Sbstract CT(n=24) and DSA (n=3) have been conducted for 24 cases of spontaneous rupture of kidney with perirenal hematoma.
分析自发性肾破裂致肾包膜下和肾周出血的CT与选择性肾动脉造影表现，以发现肾破裂病因方面的诊断价值。
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Results CT screenage could show kidney internal hemorrhage, hematom under envelope, perirenal hematoma, omental bursa hematoma.
结果 36例肾出血CT影像提示为：肾内出血、肾包膜下血肿、肾周血肿及伴网膜囊血肿等。
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Ultrasound and CT scanning are helpful with the diagnosis which may confirm the character of the lesion and the range of bleeding. If the tumour exceeds 4 cm, active treatment should be considered. Any operative management should preserve the functional nephrons as much as possible.
B超和CT检查对诊断肾错构瘤破裂出血有帮助，并能提示病变的性质以及确定出血的范围，直径大于4cm的肾错构瘤应积极手术治疗，手术时应尽量保留有功能的肾组织。
- 更多网络解释与肾出血相关的网络解释 [注：此内容来源于网络，仅供参考]
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intraventricular hemorrhage：脑室内出血
预防新生儿脑室内出血(intraventricular hemorrhage)E. 预防子痫发作(eclamptic seizures)D. 纤维蛋白(fibrin)的沉积增加B. 糖尿是常见的现象,因为肾小管的再吸收能力(capacity)被超C. 血清中尿酸与肌酐酸(creatinine)的浓度因胎儿的存在而提高450nm 的吸光值).
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occult blood：潜血反应
O.B潜血反应 (Occult Blood) 有少量出血或溶血时,用肉眼看不出血液的红色,由O.B测定有没有血红素存在就知道有无出血.常见原因:结石,感染性疾病,肾丝球肾炎,肾盂肾炎,摄护腺肿大,药物,肿瘤
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hepatorrhagia：肝出血
hepatorenal syndrome 肝肾综合征 | hepatorrhagia 肝出血 | hepatorrhaphy 肝缝术
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nephropyosis：肾脓肿
nephropyeloplasty 肾盂成形术 | nephropyosis 肾脓肿 | nephrorrhagia 肾出血
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nephropyosis：肾化脓
\\"肾盂肾炎\\",\\"nephropyelitis,pyelonephritis\\" | \\"肾化脓\\",\\"nephropyosis\\" | \\"肾出血\\",\\"nephrorrhagia\\"
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nephrorrhagia：肾出血
nephropexianephropexy 肾固定术 | nephrorrhagia 肾出血 | nephrorrhaphy 肾缝术
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benign recurrent nephrorrhagia：良性反复性肾出血
benign recurrent hematuria 良性反复发作性血尿,良性再发性血尿 | benign recurrent nephrorrhagia 良性反复性肾出血 | benign Sertoli's cell tumor 睾丸良性支持细胞瘤
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nephrorrhaphy：肾缝术
nephrorrhagia 肾出血 | nephrorrhaphy 肾缝术 | nephrosclerosis 肾硬化
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hypertensive nephrosclerosis：高血压肾硬变
hypertensive hemorrhage 高血压性出血 | hypertensive nephrosclerosis 高血压肾硬变 | hypertensive renal disease 高血压肾病
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hematoma,perirenal：肾周血肿
肾血肿 hematoma of kidney | 肾周血肿 hematoma,perirenal | 肾出血 hemorrhage of kidney