摘要
目的分析自发性肾破裂(Wunderlich综合征)诊疗过程,探讨其病因、发病机制、临床表现,以及可能存在的漏诊原因。方法回顾性分析1例维持性血液透析男性患者在透析中发生自发性肾脏破裂及相关诊断治疗,并结合文献复习进行讨论。结果患者男,35岁,维持性血液透析10个月、血压升高2周入院,血液透析结束前30 min出现左侧腰痛,且与体位变化有关,并伴左下腹胀痛及呕吐。完善腹部CT后考虑左肾自发性破裂,急诊行经皮超选择性动脉造影术+左肾动脉栓塞术,术后依次行连续肾脏替代疗法治疗、无抗凝剂血液透析、抗感染、降压等对症治疗后患者病情好转出院。结论肾破裂的发生与明显的腹部外伤等相关。然而,该患者在无明显病因的情况下出现非特异性腹痛,应引起警惕。此时,需考虑罕见原因,如自发性肾破裂。由于自发性肾破裂症状不典型,因此诊断较复杂,易误诊为肾绞痛,导致治疗延误,影响患者预后。
Objective To analyze the treatment course,etiology,pathogenesis,clinical manifestations and potential causes for the misdiagnosis of Wunderlich syndrome(spontaneous renal rupture).Methods Spontaneous renal rupture during dialysis in a male patient on maintenance hemodialysis and the associated diagnostic and therapeutic treatments were retros pectively analyzed,and relevant literatures were reviewed.Results A 35-year-old male patient admitted for 10 months of maintenance hemodialysisandelevated blood pressure for 2 weeks.He developed the left-sided lumbar pain 30 minutes before the end of the hemodialysis session,which was associated with changes in body position and accompanied by distension of the lower left abdomen and vomiting.Following a comprehensive abdominal CT scan,spontaneous rupture of the left kidney was suspected.The patient was treated with an emergencyl percutaneous superselective arteriography and left renal artery embolization.After receiving successive postoperative treatments including continuous renal replacement therapy,anticoagulant-free hemodialysis,anti-infection therapy,and antihypertensive measures,the patient's condition was improved and discharged.Conclusion Typically,the occurrence of renal rupture is associated with clear causative factors such as abdominal trauma.However,this patient developed non-specific abdominal pain without obvious causes that should be concerned.At this time,rare causes such as spontaneous renal rupture(Wunderlich syndrome) need to be considered.Due to the atypical manifestations of Wunderlich syndrome,its diagnosis is complicated and prone to the misdiagnosis of renal colic,further leading to delayed treatment and poor prognosis.
作者
代菁
陈华茜
Dai Jing;Chen Huaqian(Department of Nephrology,Dongfeng General Hospital of Sinopharm,Hubei University of Medicine,Shiyan 442000,China)
出处
《临床荟萃》
CAS
2023年第12期1107-1111,共5页
Clinical Focus
关键词
肾破裂
破裂
自发性
连续性肾脏替代疗法
动脉闭塞性疾病
肾动脉梗阻
肾动脉栓塞术
全身炎症反应综合征
renal rupture
rupture,spontaneous
continuous renal replacement therapy
arterial occlusive disease
renal artery obstruction
renal artery embolization
maintenance hemodialysis
systemic inflammatory response syndrome
