小肿瘤经皮肾冷冻消融后的肾坏疽。

Q4 Medicine
Journal of Endourology Case Reports Pub Date : 2020-12-29 eCollection Date: 2020-01-01 DOI:10.1089/cren.2020.0139
Peter Fisker Vedel, Jens Borgbjerg, Tommy Kjærgaard Nielsen
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引用次数: 0

摘要

背景:在选定的病例中,冷冻消融是治疗小肾肿块的有效选择。该手术通常被认为是肿瘤有效的,严重并发症的发生率低。我们在此报告一例62岁男性经皮冷冻消融后肾脏出现严重坏疽。病例介绍:一名62岁男性偶然被诊断为45毫米肾细胞癌。肿瘤是在怀疑憩室炎的CT扫描中发现的。发现乙状结肠处有脓肿,他接受了抽吸和抗生素治疗。20天后行经皮冷冻消融治疗。术后第三天,患者因尿脓毒症再次入院。CT扫描显示消融部位有坏疽,并行肾切除术。临床进展缓慢,新的CT扫描显示乙状结肠脓肿重建,怀疑结肠肿瘤。结肠镜检查和活检证实了这一点。患者行右半结肠切除术,病理报告为T4腺癌,边缘呈阳性。随访4个月后,发现肺转移,患者接受进一步的肿瘤治疗。结论:肾脏冷冻消融术通常是一种非常安全的手术,但可能会发生严重的并发症。本病例报告强调,应注意最近的腹部感染和延迟干预可能是在选定的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Gangrene of the Kidney Following Percutaneous Renal Cryoablation of a Small Tumor.

Background: In selected cases cryoablation is a valid treatment option for small renal masses. The procedure is generally considered oncologically efficient with a low rate of severe complications. We report here a case of a 62-year-old man who after percutaneous cryoablation develops severe gangrene in the treated kidney. Case Presentation: A 62-year-old man was incidentally diagnosed with a 45-mm renal cell carcinoma. The tumor was found on a CT scan performed on the suspicion of diverticulitis. An abscess in relation to the sigmoid was found and he was treated with aspiration and antibiotics. The tumor was treated with percutaneous cryoablation 20 days later. On the third postoperative day, he was readmitted with urosepsis. A CT scan revealed gangrene at the ablation site, and a nephrectomy was performed. Clinical progress was slow, and a new CT scan showed reformation of the abscess at the sigmoid and a suspicion of a colonic tumor was raised. This was confirmed by coloscopy and biopsy. The patient had a right hemicolectomy, and the pathology report described a T4 adenocarcinoma with positive margins. After 4 months follow-up, metastases to the lungs was found and the patient was referred to further oncologic treatment. Conclusion: Renal cryoablation is generally a very safe procedure, but severe complications may occur. This case report highlights that attention should be given to recent abdominal infections and that delayed intervention might be in place in selected cases.

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