原发性腹膜后纤维化的微创治疗  

Combined management of idiopathic retroperitoneal fibrosis

作　　者：李晓东[1] 孙光[1] 刘晓强[1] 刘硕[1] 

机构地区：[1]河南大学淮河医院泌尿科,河南开封475000

出　　处：《中国现代医学杂志》2009年第13期2063-2065,2069,共4页China Journal of Modern Medicine

摘　　要：目的分析分别采用外科手术及双J管引流+糖皮质激素治疗的原发性腹膜后纤维化患者的随访结果,探讨原发性腹膜后纤维化的治疗方法。方法19例患者中9例行开放手术,7例行双输尿管松解+腹腔间置术,2例松解失败者行肾造瘘术。10例患者通过膀胱镜或输尿管镜置入双J管引流。17例患者给予口服糖皮质激素治疗。结果行双输尿管松解并腹腔间置术的患者有6例得到随访,随访期内肾盂扩张减轻或基本消失,血肌酐下降至正常水平或稳定在轻度升高的代偿状态。2例行肾造瘘术治疗的患者,分别从术后3个月、7个月开始反复发生尿路感染,1例需要血液透析治疗。行双J管引流+强的松治疗的患者有9例得到随访,在保留双J管期间症状消失,肾积水消失或明显减轻,血肌酐平均(103±48)μmmol/L。拔除双J管后有3例复发再次置入双J管。3例中有2例已拔管,症状无复发,另1例仍保留双J管。结论双J管引流+糖皮质激素治疗原发性腹膜后纤维化,方法简单,创伤小,虽有复发但近期疗效与开放手术差别不大,远期效果有待进一步观察。[Objective] We reported 19 cases of idiopathic retroperitoneal fibrosis which treated by open operation or drainage of double J tube combined glueoeorticoid in order to improving the therapeutie effect of the disease. [Methods] There are 9 cases treated by open operation, in 7 of which ureterolysis and placement into abdominal cavity were performed, and in the other 2 cases kidney fistulation was undertaken because of failure of ureterolysis. In 10 eases endoscopie stent manipulation of double J tube was undertaken. Glucocorticoid was given after operation in 17 patients. [Results] 6 cases which were undertaken ureterolysis were followed up, whose symptoms disappeared and renal function recovered or kept lightly in Cr easing state. The 2 eases undertaken kidney fistulation took place urinary tract infection repeatedly after 3 months and 7 months respectively from operation. And 1 ease need hematodialysis therapy. There are 9 cases which undertaken endoscopic stent of double J tube combined prednisone were followed up, in whom hydronephrosis disappeared or relieved obviously and serum Cr averaged （103＋48） μmmol/L when keeping the double J tube. In 3 eases hydronephrosis was reeurred after removing the tube. So the tube was placed again in the 3 case. After 1 year the double J tube was removed in 2 of the 3 cases and the symptom didn＇t recurred. The other cases still kept the tube. [Conclusion] The ways of endoseopie stent manipulation of double J tube combined prednisone treated IRF was simple and micro-wounded. The therapeutic effect was as similar as open operation＇s in the near future though recurred in some patients. The long-term effect of the therapy still need more observation

关 键 词：原发性腹膜后纤维化 治疗 手术 双J管 糖皮质激素 

分 类 号：R572.2[医药卫生—消化系统]