在长期血液透析患者中模仿脏破裂的自发周围脏出血:一个病例报告
Zhen Wang1, Bo Yang2, Yi Zhang3
1Department of Nephrology Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University) Shanghai China.
Clinical case reports
|February 9, 2026
概括
在血液透析患者中,自发周围出血 (SPH) 很难区分于自发破裂 (SRR). 病理学证实了SPH,强调了在这些复杂的病例中需要进行手术探索和量身定制的抗凝药.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 放射学 放射学是一门学科.
- 血管外科 血管外科
背景情况:
- 自发周围脏出血 (SPH) 和自发脏破裂 (SRR) 是罕见的,通常是放射学上无法区分的紧急情况,特别是在血液透析患者中.
- 患有SPH/SRR的血液透析患者存在诊断和管理方面的挑战,原因是潜在的尿血病相关血管病变和抗凝剂的使用.
研究的目的:
- 报告一个血液透析患者的SPH病例,最初被误诊为SRR.
- 突出CT的诊断局限性,病理诊断的重要性,以及该患者群体中SPH的管理考虑.
主要方法:
- 一个53岁的男性长期接受血液透析,在低分子量肝素后出现急性侧侧疼痛的病例报告.
- 与对比度增强的CT,紧急血管造影试图栓塞,随后进行紧急切除术.
- 术后病理检查,以确定确诊和分析抗凝策略.
主要成果:
- 与对比度增强的CT表明SRR,但血管图显示没有活跃的扩张,并失败了栓塞.
- 病理学证实了SPH与围脂肪出血,排除了瘤,囊破裂,动脉瘤或血管炎.
- 患者接受了成功的切除术,术后调整了抗凝剂,表现出良好的康复.
结论:
- CT成像在区分SPH和SRR方面存在局限性,大型血液瘤.
- 当栓塞无效时,应考虑囊外出血,而病理学对于确定诊断至关重要.
- 个性化抗凝策略和早期手术干预对于在血液透析患者中管理SPH至关重要.
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