Ciudin A, Huguet J, García-Larrosa A, Musquera M, Alvarez-Vijande J R, José Ribal M, Alcaraz A
Servicio de Urología, Instituto Clínico de Nefrología y Urología, Hospital Clínic, Barcelona, España.
Actas Urol Esp. 2011 Nov-Dec;35(10):615-9. doi: 10.1016/j.acuro.2011.05.003. Epub 2011 Jul 20.
Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results.
To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy.
We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed.
Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17 to 25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61 to 92 months was favorable.
Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients.
部分肾切除术后出血可分为即刻出血或延迟出血，可能会产生严重后果。这种并发症的发生率较低。延迟出血最常见的原因是动脉假性动脉瘤。超选择性栓塞是一种可行的治疗选择，已显示出良好的效果。
评估我们系列部分肾切除术患者延迟出血的治疗方法及结果。
我们对部分肾切除术数据库进行了回顾性研究。确定发生延迟出血（出院后）的患者。回顾临床病史并分析有关临床表现、诊断、治疗及结果的数据。
在我们的部分肾切除术患者系列中，有3例发生延迟出血（1.3%）。症状出现在术后17至25天，表现为血尿或腰痛。通过超声、腹部计算机断层扫描和肾血管造影进行诊断。所有3例患者均诊断为复杂性假性动脉瘤，所有患者均接受了肾动脉导管插入术及选择性肾动脉栓塞。所有患者出血均得到即刻控制。随访61至92个月后的结果良好。
对于血流动力学稳定的患者，选择性血管栓塞是部分肾切除术后肾假性动脉瘤的首选治疗方法。
