Murakami M
National Sanatorium, Nago.
Masui. 1993 Sep;42(9):1367-70.
The author experienced a case of ruptured renal arterial aneurysm diagnosed at 32 weeks of gestation. The patient was a 32-year-old healthy woman. On admission she and her fetus were in pre-shock state. Emergency caesarean section was performed under spinal anesthesia. Postoperative CT scanning revealed the ruptured right renal artery aneurysm and hematoma around the right renal hilus. About 7 hours after caesarean section, laparotomy was performed for right nephrectomy and subtotal hysterectomy. Blood loss during operation was about 8000 ml, but postoperative course was good and she and her baby had no complications. It is suggested that arterial wall of pregnant woman has weakness due to morphological and biochemical alterations following hormonal change. Pregnant uterine compresses and dislodges abdominal aorta and inferior vena cava, and these vessel moves in a curve in a leftword and dorsal direction. Plasma volume increases in late pregnancy, therefore intra-arterial pressure is elevated. It is proposed that alterations of vessel wall, increases of circulatory blood volume and vessel displacement are implicated to the etiology of renal arterial aneurysm of pregnant woman. Pregnancy-related renal arterial aneurysm has a high risk of rupture and it is advisable to think of ruptured renal arterial aneurysm as one of the causes of hemorrhagic shock during pregnancy.
作者遇到一例在妊娠32周时诊断出的肾动脉动脉瘤破裂病例。患者为一名32岁的健康女性。入院时她和胎儿处于休克前期状态。在脊髓麻醉下进行了急诊剖宫产。术后CT扫描显示右肾动脉动脉瘤破裂以及右肾门周围血肿。剖宫产术后约7小时，进行剖腹手术以行右肾切除术和子宫次全切除术。术中失血约8000毫升，但术后病程良好，她和她的宝宝均无并发症。提示孕妇动脉壁因激素变化后形态和生化改变而出现薄弱。妊娠子宫压迫并推移腹主动脉和下腔静脉，这些血管向左后方呈曲线移动。妊娠晚期血浆容量增加，因此动脉内压力升高。有人提出血管壁改变、循环血容量增加和血管移位与孕妇肾动脉动脉瘤的病因有关。妊娠相关肾动脉动脉瘤破裂风险高，应将肾动脉动脉瘤破裂视为妊娠期间出血性休克的原因之一。
