腹膜后纤维化26例的诊治分析  

Diagnosis and treatment of retroperitoneal fibrosis： report of 26 cases

作　　者：蔡林[1] 周利群[1] 何志嵩[1] 李宁忱[1] 潘柏年[1] 

机构地区：[1]北京大学第一医院泌尿外科,100034

出　　处：《中华外科杂志》2008年第10期749-751,共3页Chinese Journal of Surgery

摘　　要：目的通过对本组患者临床资料的分析，提高对腹膜后纤维化的诊断和治疗水平。方法总结分析我院1996年1月至2007年5月收治的26例腹膜后纤维化患者的外科诊治情况。术前行CT检查、磁共振、B超、逆行尿路造影检查、肾动态显像等检查。14例急性发病和全身情况较差的患者首选输尿管双J管引流术或肾盂穿刺造瘘术。共进行开放手术治疗15例，其中9例行输尿管松解腹腔内置术。结果26例均行B超检查，发现腹膜后肿块者3例。21例行CT检查，确诊18例，准确率86％。14例行磁共振检查，确诊8例，准确率57％。治疗后随访1～106个月，平均15个月。经输尿管双J管置入或肾盂穿刺造瘘术引流后平均血肌酐浓度由373．9μmol／L降至157．1μmol／L。输尿管松解腹腔内置术的疗效满意，平均血肌酐浓度由术前171．0μmol／L降至139．6μmol／L。4例患者随访超过24个月，经B超和静脉肾盂造影检查未见肾积水征象。结论CT检查诊断准确率相对较高。及时合理的外科治疗可有效保护腹膜后纤维化患者的肾功能，而输尿管松解腹腔内置术是有效的手术治疗方法。Objective To evaluate and improve the diagnosis and surgical treatment of the retroperitoneal fibrosis （RPF）. Methods The medical records of 26 patients with the RPF （21 men and 5 women with mean age 54 years） were analyzed retrospectively. They were been treated from January 1996 to May 2007. Fourteen cases received double-Jinter-ureter drainage or pricking pyelostomy and 9 of 15 cases who received open surgery were performed bilateral ureterolysis with their ureters translocated intraperitoneally. Results For masses in retroperitoneal space, the diagnostic rate of B mode uhrasonography, CT and MRI was 12% （3/26）, 86% （18/21） and 57% （8/14） respectively. The patients were followed up from 1 to 106 months. After drained by double-Jinter-ureter stent or pricking pyelostomy, the mean serum creatinine level decreased from 373.9 μmol/L to 157.1 μmol/L of 14 patients. Those patients who underwent ureterolysis with ureteral intraperitoneal translocation had good results and their mean serum creatinine level decreased from 171.0 μmol/L before operation to 139. 6 /μmol/L after operation. Four patients had normal B-ultrasound and intravenous urogram findings with at least 24 months of follow-up. Conclusions CT scan has better accuracy for diagnosis of the RPF than B mode ultrasonography and MRI. Prompt and appropriate relief of urinary obstruction with surgical intervention can effectively protect the renal function in patients with the RPF, and the ureterolysis with ureteral intraperitoneal translocation is an effective surgical procedure to treat this disease.

关 键 词：腹膜后纤维化 诊断 治疗 

分 类 号：R686[医药卫生—骨科学]