Hellström P A, Mehik A, Talja M T, Siniluoto T M, Perälä J M, Leinonen S S
Division of Urology, Oulu University Hospital, Finland.
Scand J Urol Nephrol. 1999 Feb;33(1):17-23. doi: 10.1080/003655999750016212.
Spontaneous perirenal haemorrhage is a rare abdominal emergency most commonly caused by solid renal tumours. The aim of this study was to evaluate the efficacy of different diagnostic methods and treatment modalities.
A total of 9 patients (5 women and 4 men) with spontaneous subcapsular or perirenal haemorrhage caused by renal tumours were treated at two Finnish central hospitals over a period of 20 years.
All the patients presented with flank pain, often severe and associated with a palpable mass and a reduced haemoglobin concentration. Ultrasonography was abnormal in all cases where it was used, but was able to show the tumour and haemorrhage correctly in only one case (13%). Computed tomography had a sensitivity of 71%. Seven patients underwent extrafascial nephrectomy (5 renal cell cancers, 1 malignant oncocytoma and 1 angiomyolipoma) and two with known tuberous sclerosis and bilateral renal angiomyolipomas were treated by superselective embolization. As these few cases were all individual and were collected over a long period of time, general statements about diagnosis and treatment must be approached critically. It may be concluded, however, that spontaneous perirenal haemorrhage is often a surgical emergency necessitating great efforts in terms of diagnosis and treatment. Computed tomography should be performed on all patients nowadays. If the bleeding is caused by a malignant tumour, extrafascial nephrectomy is the treatment of choice. For those with benign tumours selective embolization should be used.
自发性肾周出血是一种罕见的腹部急症，最常见的病因是肾脏实体肿瘤。本研究的目的是评估不同诊断方法和治疗方式的疗效。
在20年的时间里，芬兰两家中心医院共治疗了9例因肾肿瘤导致自发性肾包膜下或肾周出血的患者（5例女性，4例男性）。
所有患者均表现为胁腹痛，通常较为严重，并伴有可触及的肿块和血红蛋白浓度降低。所有接受超声检查的病例结果均异常，但仅1例（13%）能正确显示肿瘤和出血情况。计算机断层扫描的敏感性为71%。7例患者接受了筋膜外肾切除术（5例肾细胞癌、1例恶性嗜酸细胞瘤和1例血管平滑肌脂肪瘤），2例患有已知结节性硬化症和双侧肾血管平滑肌脂肪瘤的患者接受了超选择性栓塞治疗。由于这些病例数量少且都是个别情况，且收集时间较长，因此关于诊断和治疗的一般性结论必须谨慎对待。然而，可以得出结论，自发性肾周出血通常是一种外科急症，在诊断和治疗方面需要付出巨大努力。如今，所有患者均应进行计算机断层扫描。如果出血是由恶性肿瘤引起的，筋膜外肾切除术是首选治疗方法。对于良性肿瘤患者，应采用选择性栓塞治疗。
