急性梗阻性自发性尿外渗的诊治  

Diagnosis and treatment of spontaneous urinary extravasation with acute urinary tract obstruction

作　　者：郑宇朋[1] 张光银 

机构地区：[1]首都医科大学附属北京同仁医院泌尿外科,100730

出　　处：《临床外科杂志》2012年第12期870-872,共3页Journal of Clinical Surgery

摘　　要：目的探讨急性梗阻性自发性尿外渗的临床表现、诊断和治疗。方法3例急性梗阻性自发性尿外渗患者，均急诊行膀胱镜留置患侧输尿管双J管内引流。结果3例就诊时KUB表现未发现尿路结石。CT扫描3例均存在患侧肾盂输尿管扩张积水伴尿外渗表现，2例为右输尿管结石，1例为结肠癌侵犯左输尿管下段。术后1-2d腰腹痛症状消失，恢复排气排便。其中2例结石患者，予以体外冲击波碎石或输尿管镜碎石术治疗后排净结石。1例结肠肿瘤侵犯输尿管，保留输尿管内引流，转肿瘤外科治疗。3例术后5-14d复查CT示尿外渗消失。结论急性梗阻性自发性尿外渗为尿路梗阻后继发的临床综合征，早期诊断较为困难，确诊主要依靠影像学检查。尽早解除尿路梗阻是本病治疗的原则。Objective To investigate the manifestation, diagnosis and treatment of spontaneous u- rinary extravasation with acute urinary tract obstrnction（SUEAUTO）. Methods The clinical data of 3 ca- ses of SUEAUTO underwent cystoscopy emergently and double-.l stents were placed in the affected ureters. Results No urinary calculi was found on the KUB of the three patients before treatment. Hydronephrosis, ureterectasia and urinary extravasation on the CT scan were observed in all cases. The CT scan showed the causes of urinary tract obstrnction were ureteric stone in two cases and colon cancer in the other. Abdomi- nal pain and intestinal obstruction symptoms of the 3 cases disappeared 1 - 2 days after operation. Two ca- ses with ureteric stones were treated with ureteroscopic lithotripsy or extracovporeal shock wave lithotripsy. The case with colon cancer was transferred to the department of surgical oncology and the ureteral stent was reserved for internal drainage. CT scan was rechecked 5 - 14 days after operation in all cases, and the re- suits showed that the urinary extravasation disappeared. Conclusion SUEAUTO is one of clinical syn- dromes secondary to urinary tract obstruction, which may be accompanied with intestinal obstruction and lead to difficulties in early diagnosis and accurate diagnosis. CT scan examination has important value in the diagnosis and differential diagnosis of SUEAUTO. The treatment principles are to relieve the obstruction and drain the extravasation as soon as possible.

关 键 词：尿路梗阻 自发性尿外渗 

分 类 号：R69[医药卫生—泌尿科学]