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流行性出血热(EHF)并发肾脏被膜下巨大血肿临床少见,属危重型,病情凶险,我们收治2例,报告如下.例1,患者男性,48岁,18天前无明显诱因发热、腰痛,5天后出现少尿,持续7天后尿量逐渐增多,于2大前出现血尿,右腰痛加剧,入院治疗.查体:右上腹可触及成人手拳大肿物,压痛“+”,右肾区压痛“+”,叩击痛“+T n”.实验室检查:血红蛋白75g/L,红细胞2.12×10~(12)/L,尿素氮11.07mmol/L,肌酐265.2μmol/L.B超示右肾包膜下见8.5cm×6.5cm暗区,诊断为EHF并发肾脏被膜下巨大血肿,经内科治疗3周余,症状消失,复查B超该暗区无缩小,在B超引导下穿刺抽击少量陈旧血性液,遂行右肾被膜下血肿清陈术,术中见右肾被膜紧张,背侧隆起约8.5cm×6.5cm×2.5cm,清除陈旧性血凝块及血性液约100ml,肾实质受压内陷,无破损.术后病愈出院.
Epidemic hemorrhagic fever (EHF) complicated with renal capsule under the huge hematoma is rare, is critically ill, dangerous, we admitted 2 cases, the report is as follows.Example 1, male patients, 48 years old, 18 days ago no obvious incentive for fever, back pain, 5 days after oliguria, urine volume gradually increased after 7 days, hematuria in front of 2 large, right lower back pain aggravated, hospitalized. Physical examination: right upper quadrant palpable large hand mass, tenderness “+”, right kidney area Tenderness “+”, percussion pain “+ T n.” Laboratory tests: hemoglobin 75g / L, red blood cells 2.12 × 10-12 / L, urea nitrogen 11.07mmol / L, creatinine 265.2μmol / Membrane see 8.5cm × 6.5cm dark area, the diagnosis of EHF complicated with renal capsule under the huge hematoma, after medical treatment for more than 3 weeks, the symptoms disappear, review of the B-dark area without shrinkage, B-guided puncture under a small amount of stale Bloody fluid, the right kidney under subretinal hematoma surgery, see the right renal capsule tension, dorsal raise about 8.5cm × 6.5cm × 2.5cm, remove the old blood clots and bloody fluid about 100ml, renal parenchymal pressure Invade, without damage.