帝王切開後に破裂した左腎動脈瘤の1手術例
腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが，帝王切開後に破裂した腎動脈瘤に対し，緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する．症例は31歳女性．妊娠糖尿病で近医通院中，常位胎盤早期剥離のため緊急帝王切開術を施行された．児娩出17時間後に突然の左腰痛と背部痛が出現しCT上左腎動脈瘤の破裂を認めた．瘤のコイルパッキングを施行したが，瘤が大きいため完全にパッキングすることができず手術を施行した．後腹膜アプローチで瘤を切除し端々吻合にて腎動脈を再建，術後経過良好で腎機能を温存することができた．帝王切開後に破裂した稀な腎動脈瘤に対し，手術治療により良好な結果を得られた．...
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| Published in | Japanese Journal of Vascular Surgery Vol. 20; no. 6; pp. 855 - 859 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本血管外科学会
2011
日本血管外科学会 JAPANESE SOCIETY FOR VASCULAR SURGERY |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.20.855 |
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| Abstract | 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが，帝王切開後に破裂した腎動脈瘤に対し，緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する．症例は31歳女性．妊娠糖尿病で近医通院中，常位胎盤早期剥離のため緊急帝王切開術を施行された．児娩出17時間後に突然の左腰痛と背部痛が出現しCT上左腎動脈瘤の破裂を認めた．瘤のコイルパッキングを施行したが，瘤が大きいため完全にパッキングすることができず手術を施行した．後腹膜アプローチで瘤を切除し端々吻合にて腎動脈を再建，術後経過良好で腎機能を温存することができた．帝王切開後に破裂した稀な腎動脈瘤に対し，手術治療により良好な結果を得られた． |
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| AbstractList | 「要旨」: 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが, 帝王切開後に破裂した腎動脈瘤に対し, 緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する. 症例は31歳女性. 妊娠糖尿病で近医通院中, 常位胎盤早期剥離のため緊急帝王切開術を施行された. 児娩出17時間後に突然の左腰痛と背部痛が出現しCT上左腎動脈瘤の破裂を認めた. 瘤のコイルパッキングを施行したが, 瘤が大きいため完全にパッキングすることができず手術を施行した. 後腹膜アプローチで瘤を切除し端々吻合にて腎動脈を再建, 術後経過良好で腎機能を温存することができた. 帝王切開後に破裂した稀な腎動脈瘤に対し, 手術治療により良好な結果を得られた. 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが，帝王切開後に破裂した腎動脈瘤に対し，緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する．症例は31歳女性．妊娠糖尿病で近医通院中，常位胎盤早期剥離のため緊急帝王切開術を施行された．児娩出17時間後に突然の左腰痛と背部痛が出現しCT上左腎動脈瘤の破裂を認めた．瘤のコイルパッキングを施行したが，瘤が大きいため完全にパッキングすることができず手術を施行した．後腹膜アプローチで瘤を切除し端々吻合にて腎動脈を再建，術後経過良好で腎機能を温存することができた．帝王切開後に破裂した稀な腎動脈瘤に対し，手術治療により良好な結果を得られた． We describe a patient who underwent an emergency aneurysmectomy for a ruptured renal aneurysm following cesarean section, in whom renal function was preserved. A 31-year-old woman presented with gestational diabetes mellitus at a local hospital. She underwent an emergency cesarean section because of placental abruption. Left low back pain and upper back pain suddenly developed 17 hours after childbirth. A computed tomographic scan revealed a ruptured aneurysm of the left renal artery, and we performed coil packing of the aneurysm. However, complete packing was impossible because of the large size of the aneurysm. We therefore decided to operate. The ruptured aneurysm was removed through a retroperitoneal approach, and the renal artery was directly reconstructed by end-to-end anastomosis. Renal aneurysms are considered to be at high risk of rupture during pregnancy. However, to the best of our knowledge, no study has reported rupture of a renal aneurysm after cesarean section. Surgical treatment yielded a good outcome, and renal function was preserved. 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが，帝王切開後に破裂した腎動脈瘤に対し，緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する．症例は31歳女性．妊娠糖尿病で近医通院中，常位胎盤早期剥離のため緊急帝王切開術を施行された．児娩出17時間後に突然の左腰痛と背部痛が出現しCT上左腎動脈瘤の破裂を認めた．瘤のコイルパッキングを施行したが，瘤が大きいため完全にパッキングすることができず手術を施行した．後腹膜アプローチで瘤を切除し端々吻合にて腎動脈を再建，術後経過良好で腎機能を温存することができた．帝王切開後に破裂した稀な腎動脈瘤に対し，手術治療により良好な結果を得られた． |
| Author | 安田, 章沢 内田, 敬二 益田, 宗孝 井元, 清隆 南, 智行 杉浦, 唯久 |
| Author_FL | Yasuda Shota Minami Tomoyuki Imoto Kiyotaka Sugiura Tadahisa Uchida Keiji Masuda Munetaka |
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| References | 22)Pershad A, Heuser R. Renal artery aneurysm: successful exclusion with a stent graft. Catheter Cardiovasc Interv 2004;1:341-346. 16)Nolte JE, Rutherford RB, Nawaz S, et al. Arterial dissections associated with pregnancy. J Vasc Surg 1995;21: 515-520. 18)Guo X, Lu X, Ren H, et al. Estrogen modulates the mechanical homeostasis of mouse arterial vessels through nitric oxide. Am J Physiol Heart Circ Physiol 2006;290: H1788-H1797. 2)Whiteley MS, Katoch R, Kennedy RH, et al. Ruptured renal artery aneurysm in the first trimester of pregnancy. Eur J Vasc Surg 1994;8:238-239. 5)Chen R, Novick AC. Retroperitoneal hemorrhage from a ruptured renal artery aneurysm with spontaneous resolution. J Urol 1994;151:139-141. 7)Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg 2003;37:293-300. 21)Andersen PE, Rohr N. Endovascular exclusion of renal artery aneurysm. Cardiovasc Intervent Radiol 2005;28:665-667. 1)Rijgbroek A, Dijk HAV, Roex AJM. Rupture of renal artery aneurysm during pregnancy. Eur J Vasc Surg 1994;8:375-376. 17)Karas RH, Patterson BL, Mendelsohn ME. Human vascular smooth muscle cells contain functional estrogen receptor. Circulation 1994;89:1943-1950. 20)Slavin RE, Cafferty L, Cartwright J. Segmental Mediolytic arteritis; Aclinicopathologic and ultrastructual study of two cases. Am J Surg Pathol 1989;13:558-568. 19)Slavin RE, Gonzalez-Vitale JC. Segmental mediolytic arteritis: a clinical pathologic study. Lab Invest 1976;35:23-29. 6)Lacroix H, Bernaerts P, Nevelsteen A, et al. Ruptured renal artery aneurysm during pregnancy: successful ex situ repair and autotransplantation. J Vasc Surg 2001;33:188-190. 8)Fraser GE, Poncia H. Spontaneous renal artery aneurysm rupture: an unusual cause of abdominal pain and syncope. Emerg Med J 2009;26:619-620. 3)Schorn B, Falk V, Dalichau H, et al. Kidney salvage in a case of ruptured renal artery aneurysm: case report and literature review. Cardiovasc Surg 1997;5:134-136. 4)Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysm: case report with review and update of the literature. Int Urol Nephrol 2004;36:409-416. 10)Gutta R, Lopes J, Flinn WR, et al. Endovascular embolization of a giant renal artery aneurysm with preservation of renal parenchyma. Angiology 2008;59:240-243. 12)久保田恵章，土屋朋大，亀井信吾，他．塞栓術が有効であった腎動脈瘤切迫破裂の1例．泌尿器科紀要 2006;52:349-352. 11)Hagihara M, kitagawa A, Izumi Y, et al. Emergent coil embolization for ruptured renal artery aneurysm. Jpn J Radiol 2009;27:275-279. 13)Prabulos AM, Chen HH, Rodis JF, et al. Angiographic embolization of a ruptured renal artery aneurysm during pregnancy. Obstet Gynecol 1997;90:663-665. 14)Graff J, Schälte G, jovanovic V. Rupture of a renal artery aneurysm during delivery. Aktuelle Urol 2003;34:350-353. 15)Pedowitz P, Perell A. Aneurysms complicated by pregnancy, part I: aneurysms of the aorta and major branches. Am J Obstet Gynecol 1957;73:720-735. 9)Schneidereit NP, Lee S, Morris DC, et al. Endovascular repair of a ruptured renal artery aneurysm. J Endovasc Ther 2003;10:71-74. |
| References_xml | – reference: 2)Whiteley MS, Katoch R, Kennedy RH, et al. Ruptured renal artery aneurysm in the first trimester of pregnancy. Eur J Vasc Surg 1994;8:238-239. – reference: 8)Fraser GE, Poncia H. Spontaneous renal artery aneurysm rupture: an unusual cause of abdominal pain and syncope. Emerg Med J 2009;26:619-620. – reference: 3)Schorn B, Falk V, Dalichau H, et al. Kidney salvage in a case of ruptured renal artery aneurysm: case report and literature review. Cardiovasc Surg 1997;5:134-136. – reference: 9)Schneidereit NP, Lee S, Morris DC, et al. Endovascular repair of a ruptured renal artery aneurysm. J Endovasc Ther 2003;10:71-74. – reference: 14)Graff J, Schälte G, jovanovic V. Rupture of a renal artery aneurysm during delivery. Aktuelle Urol 2003;34:350-353. – reference: 19)Slavin RE, Gonzalez-Vitale JC. Segmental mediolytic arteritis: a clinical pathologic study. Lab Invest 1976;35:23-29. – reference: 22)Pershad A, Heuser R. Renal artery aneurysm: successful exclusion with a stent graft. Catheter Cardiovasc Interv 2004;1:341-346. – reference: 15)Pedowitz P, Perell A. Aneurysms complicated by pregnancy, part I: aneurysms of the aorta and major branches. Am J Obstet Gynecol 1957;73:720-735. – reference: 1)Rijgbroek A, Dijk HAV, Roex AJM. Rupture of renal artery aneurysm during pregnancy. Eur J Vasc Surg 1994;8:375-376. – reference: 18)Guo X, Lu X, Ren H, et al. Estrogen modulates the mechanical homeostasis of mouse arterial vessels through nitric oxide. Am J Physiol Heart Circ Physiol 2006;290: H1788-H1797. – reference: 13)Prabulos AM, Chen HH, Rodis JF, et al. Angiographic embolization of a ruptured renal artery aneurysm during pregnancy. Obstet Gynecol 1997;90:663-665. – reference: 21)Andersen PE, Rohr N. Endovascular exclusion of renal artery aneurysm. Cardiovasc Intervent Radiol 2005;28:665-667. – reference: 7)Pfeiffer T, Reiher L, Grabitz K, et al. Reconstruction for renal artery aneurysm: operative techniques and long-term results. J Vasc Surg 2003;37:293-300. – reference: 20)Slavin RE, Cafferty L, Cartwright J. Segmental Mediolytic arteritis; Aclinicopathologic and ultrastructual study of two cases. Am J Surg Pathol 1989;13:558-568. – reference: 5)Chen R, Novick AC. Retroperitoneal hemorrhage from a ruptured renal artery aneurysm with spontaneous resolution. J Urol 1994;151:139-141. – reference: 16)Nolte JE, Rutherford RB, Nawaz S, et al. Arterial dissections associated with pregnancy. J Vasc Surg 1995;21: 515-520. – reference: 12)久保田恵章，土屋朋大，亀井信吾，他．塞栓術が有効であった腎動脈瘤切迫破裂の1例．泌尿器科紀要 2006;52:349-352. – reference: 11)Hagihara M, kitagawa A, Izumi Y, et al. Emergent coil embolization for ruptured renal artery aneurysm. Jpn J Radiol 2009;27:275-279. – reference: 4)Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysm: case report with review and update of the literature. Int Urol Nephrol 2004;36:409-416. – reference: 10)Gutta R, Lopes J, Flinn WR, et al. Endovascular embolization of a giant renal artery aneurysm with preservation of renal parenchyma. Angiology 2008;59:240-243. – reference: 17)Karas RH, Patterson BL, Mendelsohn ME. Human vascular smooth muscle cells contain functional estrogen receptor. Circulation 1994;89:1943-1950. – reference: 6)Lacroix H, Bernaerts P, Nevelsteen A, et al. Ruptured renal artery aneurysm during pregnancy: successful ex situ repair and autotransplantation. J Vasc Surg 2001;33:188-190. |
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| Snippet | 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが，帝王切開後に破裂した腎動脈瘤に対し，緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報告する．... 「要旨」: 腎動脈瘤は妊娠中に破裂する危険が高い瘤とされているが, 帝王切開後に破裂した腎動脈瘤に対し, 緊急瘤切除術を施行し腎機能の温存をし得た症例を経験したので報... We describe a patient who underwent an emergency aneurysmectomy for a ruptured renal aneurysm following cesarean section, in whom renal function was preserved.... |
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| StartPage | 855 |
| SubjectTerms | Pregnancy complication Renal artery Revascularization Ruptured aneurysm コイル塞栓術 帝王切開 腎動脈瘤破裂 |
| Title | 帝王切開後に破裂した左腎動脈瘤の1手術例 |
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| ispartofPNX | 日本血管外科学会雑誌, 2011/10/25, Vol.20(6), pp.855-859 |
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