腹膜后纤维化的诊治分析(附48例报告)  

Analysis of diagnosis and treatment of retroperitoneal fibrosis(Report of 48 cases)

作　　者：刘贵中[1] 赵耀瑞[1] 王勇[1] 王庆杰[1] 刘文瞻[1] 孙光[1] 徐勇[1] 

机构地区：[1]天津医科大学第二医院泌尿外科,天津300211

出　　处：《临床泌尿外科杂志》2012年第11期839-842,共4页Journal of Clinical Urology

摘　　要：目的:探讨腹膜后纤维化致上尿路梗阻的临床特点及诊治方法。方法:回顾性分析2006～2012收治48例腹膜后纤维化患者的临床资料,泌尿系CT提示腹膜后纤维化33例(68.8%),彩超提示腹膜后纤维化18例(37.5%),12例行输尿管松解腹腔间置术,34例行输尿管插管术,6例行肾穿刺造瘘术。结果:随访6～60个月,术后患者症状消失24例,肾功能恢复正常27例,36例患者肾积水消失,需要长期透析治疗的患者2例,死亡3例,死亡原因为肾功能衰竭、晚期胃癌。2例原发性RPF行单侧输尿管松解腹腔间置术患者,分别于术后3个月和6个月出现对侧肾积水,再次手术行对侧输尿管松解腹腔间置术,术后肾积水缓解。结论:泌尿系彩超及CT检查是腹膜后纤维化的重要辅助检查,输尿管松解腹腔间置术及输尿管插管术是治疗腹膜后纤维化主要方法,肾穿刺造瘘术是危重患者及输尿管插管术失败的补救手术。单侧输尿管松解腹腔间置术可能导致对侧腹膜后渗出、纤维粘连而致对侧肾积水。Objective：To investigate the clinical characteristics, diagnosis and treatment method of upper urina- ry tract obstruction caused by retroperitoneal fibrosis（RPF）. Method：Retrospective analysis the clinical data of 48 cases of hydronephrosis caused by RPF patients from 2006 to 2012 treated in our hospital, the urinary CT promp- ted RPF in 33 cases （68.8%）, color doppler ultrasound shew RPF in 18 cases （37.5%）. Ureterolysis and intrap- eritoneal placement of the ureter, ureteral catheterization and percutaneous nephrostomy were performed in 12 ca- ses,34 cases and 6 cases respectively. Result：Followed up for 6-60 months after operation, the symptoms disap- peared in 24 cases; renal function returned to normal in 27 cases; 36 cases of patients with hydronephrosis disap- peared; 2 patients required long-term dialysis; 3 cases of death due to renal failure and advanced gastric cancer. 2 patients who received unilateral ureterolysis and intraperitoneal placement of the ureter occurred contralateral hy- dronephrosis 3 months and half a year after operation respectively and underwent the opposite side ureterolysis and intraperitoneal placement of the ureter. Conclusion：The urinary ultrasonography and CT are the important exami- nation in the diagnosis of RPF. Ureterolysis and intraperitoneal placement of the ureter and ureteral catheterization are the main means of treatment of retroperitoneal fibrosis. Percutaneous nephrostomy is the remedial operation to critical patients and failed ureteral catheterization. Unilateral ureterolysis and intraperitoneal placement of the ure- ter may cause the opposite side retroperitoneal exudation , fibrous adhesions and hydronephrosis.

关 键 词：腹膜后纤维化 肾积水 输尿管松解术 

分 类 号：R69[医药卫生—泌尿科学]