原发性腹膜后纤维化19例报告  

Management of idiopathic retroperitoneal fibrosis

作　　者：李晓东[1] 孙光[2] 刘晓强[2] 刘硕[2] 

机构地区：[1]河南大学淮河医院泌尿外科,开封475000 [2]天津医科大学第二医院泌尿外科

出　　处：《中华泌尿外科杂志》2009年第10期703-706,共4页Chinese Journal of Urology

摘　　要：目的提高原发性腹膜后纤维化患者临床治疗效果。方法原发性腹膜后纤维化患者19例。临床表现腰腹部疼痛、恶心、食欲不振、乏力、体重下降、尿量减少，体检发现双肾积水肾区叩击痛等。影像学检查表现为腹膜后软组织肿块，沿腹主动脉前方及两侧分布，包绕输尿管和下腔静脉。行开放手术9例，其中双输尿管松解加腹腔间置术7例，松解失败行肾造瘘术者2例；经膀胱镜或输尿管镜置入双J管引流10例。辅以泼尼松口服治疗17例，60mg／d连续应用6周，每周减5mg，至维持量10mg／d至少应用6个月，总疗程〉12个月。结果19例患者获随访17例，失访2例。随访时间5～81个月。行输尿管松解并腹腔间置术获随访者6例，肾积水减轻或基本消失，SCr降至正常水平或稳定在轻度升高的代偿状态。行肾造瘘术2例，分别于术后3、7个月反复发生尿路感染，1例需要血液透析治疗。行双J管引流者9例，患者症状消失，肾积水消失或明显减轻，SCr值平均（103±48）μmol／L；拔除双J管后3例复发再次置入双J管，2例再拔管后症状无复发，1例仍保留双J管。结论输尿管松解腹腔间置是治疗原发性腹膜后纤维化的有效手段；双J管引流、口服泼尼松方法简单、创伤小、近期疗效较满意，远期效果有待进一步观察。Objective To discuss the therapeutic methods of idiopathic retroperitoneal fibrosis （IRF）. Methods Nineteen cases of IRF were reviewed. The main clinical menifestation included lamber pain and nephrohydrosis, nausea, loss of appetite, body weight descend, hypourocrinia, per cussion tenderness over kidney region. The imaging showed soft tissue mass behind the peritoneum, which surrounded the abdominal aorta, and wrapped the ureter and inferior vena cava. There were 9 cases treated by open surgery, 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 cases endoscopic stent of double J stent was taken. Glucoeorticoid was given in 17 patients. Results Seventeen cases were followed up from 5 to 81 months. Six cases with ureterolysis were followed up, whose symptom disappeared and renal function recovered or kept slowly increasing state. In 2 cases undertaken kidney fistulation, urinary tract infection took place repeatedly after 3 months and 7 months respectively from operation. And 1 case needed hematodialysis therapy. There were 9 eases undertaken ureteral stent combined with prednisone were followed up, in whom hydronephrosis relieved obviously and serum Cr averaged 1034±48μmol/L when keeping the double J stent. In 3 cases hydronephrosis recurred after removing the stent. Conclusions Ureterolysis and placement into abdominal cavity is the valid treatment of IRF. The way of endoscopic stent combined prednisone treated IRF is simple, which effect is satisfied in short term.

关 键 词：腹膜后纤维化 外科手术 选择性 

分 类 号：R686[医药卫生—骨科学]