CAJ | 학술논문

目的：研究肾部分切除术后迟发性出血的发生率及选择性肾动脉栓塞在其中的应用。分析发生术后假性动脉瘤可能的高危因素。方法回顾性分析我科2000年1月至2010年12月426例保留肾单位手术的临床资料，比较其中14例迟发性出血患者与总体患者的手术方式、肿瘤大小、位置、在肾实质内的深度和是否单侧多发等可能的影响因素。结果14例患者中，12例通过肾血管造影明确诊断假性动脉瘤，其中的10例（83．3％）栓塞治疗成功，另1例开放手术止血，还有1例肾切除。2例造影未见异常，通过输液支持、止血治疗后缓解。在两组患者之间，肿瘤的大小、位置以及肿瘤是否单侧多发等因素存在显著性差异。结论肾部分切除术后假性动脉瘤发生率较低，病灶直径较大、肿瘤靠近肾蒂和同侧多发病灶是其危险因素。选择性肾动脉栓塞可以安全有效的治愈大多数此类患者，可作为首选治疗。
목적：연구신부분절제술후지발성출혈적발생솔급선택성신동맥전새재기중적응용。분석발생술후가성동맥류가능적고위인소。방법회고성분석아과2000년1월지2010년12월426례보류신단위수술적림상자료，비교기중14례지발성출혈환자여총체환자적수술방식、종류대소、위치、재신실질내적심도화시부단측다발등가능적영향인소。결과14례환자중，12례통과신혈관조영명학진단가성동맥류，기중적10례（83．3％）전새치료성공，령1례개방수술지혈，환유1례신절제。2례조영미견이상，통과수액지지、지혈치료후완해。재량조환자지간，종류적대소、위치이급종류시부단측다발등인소존재현저성차이。결론신부분절제술후가성동맥류발생솔교저，병조직경교대、종류고근신체화동측다발병조시기위험인소。선택성신동맥전새가이안전유효적치유대다수차류환자，가작위수선치료。
Objectives We aimed to evaluate the occurrence rate of partial nephrectomy derived delayed re-nal hemorrhage and its treatment using selective renal arterial embolization,and to analyze the risk factors for the incidence of post-surgical pseudoaneurysm. Methods We retrospectively analyzed the clinical data of 426 pa-tients treated with nephron-sparing surgery in our department between January 2000 and December 2010 . 14 of the 426 patients suffered from delayed renal hemorrhage. We compared the surgical approach,tumor size and lo-cation,tumor depth in the renal parenchyma,and the occurrence of unilateral multiple tumor between the 14 pa-tients with delayed renal hemorrhage and the overall 426 patients. Results Pseudoaneurysm was diagnosed by re-nal angiography in 12 out of the 14 patients with delayed renal hemorrhage. Of the 12 patients,10 (83. 3%) were successfully cured using selective renal arterial embolization,1 was treated with open surgery,and the oth-er 1 was treated with nephrectomy. For the 2 out of 14 patients that were without pseudoaneurysm,the symptom of hemorrhage was relieved by transfusion and hemostasis. We found that the size,and location of the tumor, and the unilateral multiple tumors were significantly different between the 14 patients and the total 426 patients. Conclusions Post-surgical pseudoaneurysm showed a low incidence. The risk factors for pseudoaneurysm in-clude lesion with large diameter,tumor near the renal pedicle,and unilateral multiple tumors. Most patients with pseudoaneurysm were successfully cured by selective renal arterial embolization. Therefore,selective renal arterial embolization can be used as the preferential therapy for pseudoaneurysm.