背景:静脉假性动脉瘤在钝性创伤患者中并不常见,肾静脉假性动脉瘤尤其罕见,即使肾损伤发生在大约8-10%的腹部创伤病例中。关于手术之间的治疗方式存在争议,保守的照顾,和放射性介入治疗肾静脉假性动脉瘤。我们想分享我们在保守护理下治疗肾静脉假性动脉瘤的钝性创伤患者的经验。
方法:一名53岁的女性患者在行人事故后被转移到我们的创伤中心。对比增强腹部计算机断层扫描(CT)显示右肾损伤(II级)伴有部分梗死(约30-40%)和局限于Gerota筋膜的肾周血肿,无外渗,3厘米大小的右肾静脉假性动脉瘤,肝裂伤(III级)伴少量肝周腹腔积血。因为她的生命体征稳定,在短期随访实验室检查中血红蛋白水平没有下降,我们决定在创伤重症监护病房对患者进行保守治疗,不进行血管栓塞或手术治疗.患者在右胫腓骨远端骨折OR/IF手术后第14天出院。在出院后1个月进行的CT扫描中,不再观察到肾周血肿,肾静脉假性动脉瘤几乎好转。
结论:生命体征不稳定的肾动脉损伤患者需要手术或血管栓塞。即使生命体征稳定,动脉假性动脉瘤更容易破裂;因此,需要手术或血管栓塞。相比之下,与介入治疗或手术治疗相比,静脉性假性动脉瘤可以保守治疗,因为它们由于压力相对较低而破裂的可能性较低.
结论:肾静脉假性动脉瘤非常罕见。手术,保守的照顾,应根据患者的病情考虑放射学干预。因为静脉血流量比动脉血流量慢,肾静脉假性动脉瘤,如果没有损伤需要进一步处理,如果病人的生命体征稳定,可以保守治疗。
BACKGROUND: Venous pseudoaneurysm is uncommon in blunt trauma patients, and renal venous pseudoaneurysm is especially rare, even though renal trauma occurs in approximately 8-10 % of abdominal trauma cases. There is controversy regarding the modality of treatment between surgery, conservative care, and radiologic intervention to manage renal venous pseudoaneurysms. We would like to share our experience treating blunt trauma patients having renal venous pseudoaneurysm with conservative care.
METHODS: A 53-year-old female patient was transferred to our trauma center following a pedestrian accident. Contrast-enhanced abdominal computed tomography (CT) showed right renal injury (grade II) with partial infarction (approximately 30-40 %) and peri-renal hematoma confined to Gerota\'s fascia without extravasation, a 3 cm sized right renal venous pseudoaneurysm, and a liver laceration (grade III) with a small amount of perihepatic hemoperitoneum. Since her vital signs were stable, with no decrease in the hemoglobin level in the short-term follow-up laboratory test, we decided to treat the patient conservatively in the trauma intensive care unit without angioembolization or surgery. The patient was discharged on the 14th day after OR/IF surgery for a right distal tibiofibular fracture. On a CT scan performed 1 month after discharge, a peri-renal hematoma was no longer observed, and the renal venous pseudoaneurysm had nearly improved.
CONCLUSIONS: Patients with renal arterial injury with unstable vital signs require surgery or angioembolization. Even if vital signs are stable, arterial pseudoaneurysms are more likely to rupture; therefore, surgery or angioembolization is required. In contrast, venous pseudoaneurysms can be managed conservatively compared to intervention or surgery in vitally stable patients because they have a lower possibility of rupture due to relatively low pressure.
CONCLUSIONS: Renal venous pseudoaneurysms are very rare. Surgery, conservative care, and radiologic intervention should be considered depending on the patient\'s condition. Because venous blood flow is slower than arterial blood flow, renal venous pseudoaneurysm can be treated with conservative care if there are no injuries requiring further management and if the patient\'s vital signs are stable.