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老汉尿血9个月流光一半血,血管取出4厘米长"癌栓"

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老汉尿血9个月流光一半血,血管取出4厘米长"癌栓"


原标题:老汉尿血9个月,身上一半血都流光了患上肾癌,大血管里取出4厘米长“癌栓”

最近,家住杭集镇的67岁韩大爷在家人的陪同下,来到扬大附院(扬州一院)西区分院就诊。原来,早在9个月前,韩大爷的小便反反复复带血。起初,他并没有很重视。最近情况越来越糟糕,不但血尿加重,人也变得越来越消瘦。医院诊断出的结果让他吓了一跳。

病情

六旬老人

反复尿血大半年

韩大爷是位农民,之前他的身体一直很好。9个月前,韩大爷在上厕所时,突然发现小便中带血,但并没有任何疼痛等不适症状。他就没有将此放在心上,只是用了点消炎药,之后血尿略有好转。

可是,之后的几个月里,韩大爷仍然反复出现血尿。近一个月来,他的血尿加重,几乎每天都有,且血色较鲜较浓。他一下子瘦了10多斤,面色越来越苍白。

诊断

大爷患上肾癌,只能手术救命

负责接诊的泌尿外科主任医师范其兵给韩大爷做了全面检查,最终韩大爷被确诊为右肾恶性肿瘤并伴有下腔静脉癌栓,同时还有肺部转移,病情已非常危急。范其兵在检查中还发现,韩大爷血色素仅有6克,而正常人的血色素应达到12克。

“这说明他身体里几乎一半的血已经流失。如不尽快手术治疗,会有生命危险。”范其兵分析,当然手术的风险与难度也是巨大的。“肾上的恶性肿瘤,因为没有得到及时治疗,一直长到下腔静脉里,形成像血栓一样的癌栓,长度达到惊人的4厘米。”据介绍,癌栓,是指恶性肿瘤不断生长,像血栓一样长到了血管里面。下腔静脉是人体最粗的静脉血管,直接连到心脏,还有许多重要脏器的血管与之相连,稍有不慎就会有大出血的危险。

而癌栓又不同于普通的血栓。一些普通的血栓可以通过药物溶化掉,但癌栓并不容易溶化。手术中一旦出现癌栓脱落,跑进大脑就会发生脑梗塞,跑进心脏就会发生心肌梗塞,跑进肺就会发生肺栓塞,每种情况都有可能致命。

家属得知情况后,尤如晴天霹雳。经过一周左右艰难的思想斗争,家属决定采取手术治疗,放手一搏。

抢救

一波三折拿掉右肾与癌栓

范其兵所在的团队迅速做好病人的支持治疗,每天给病人少量输血,直到达到手术要求,同时组织全院会诊。这样的大手术往往需要多科协作来共同处理。比如该患者的下腔静脉癌栓已经达到肝静脉以下,就需要请肝胆外科的协助。另外,术中麻醉对于血压的控制调节、术后ICU的严密监测也非常重要。

在手术过程中,范其兵发现手术的难度远远超出事先的预计。老人肾门血管部位黏连严重。经过一系列操作,医生终于切开下腔静脉,顺利切除右肾并取除癌栓。但此时新的问题又出现了,癌组织已经侵犯下腔静脉壁,范其兵果断决定切除部分下腔静脉壁,最大限度减少癌细胞残留。当下腔静脉切口缝合完毕后,管径只有正常的一半大小了,开放血流后血管通畅,没有任何漏血。

此时,台上的医护人员才松了一口气。手术经过四个半小时终于成功完成。术后当天,患者的尿色就转清了,现患者恢复顺利,肝、肾功能等指标正常,正准备下一步的药物治疗。

提醒

发现尿血应及时检查治疗

范其兵分析,造成血尿的疾病有很多种,通常大多数血尿与泌尿生殖系统疾病有关,常见的有泌尿系感染、结石、前列腺疾病、肿瘤、创伤等。少数病人在没有明显诱因的情况下突然出现肉眼血尿,但又没有疼痛等其他表现时,临床上称为“无痛性肉眼血尿”。

无痛性肉眼血尿多见于老年患者,通常被视为泌尿系统肿瘤的重要警示信号,尤其要加以重视。老年人是肿瘤的高发人群。“韩大爷的病情如果早到医院检查,就不会发展到这么严重。”范其兵提醒市民,一定要注意定时体检,如发现血尿,更应及时到医院检查治疗。

通讯员仇上斌记者周阳


责任编辑:syz







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