腹膜后纤维化致肾积水52例诊治分析  

Diagnosis and treatment of hydronephrosis induced by retroperitoneal fibrosis(a report of 52 cases)

作　　者：姜明东[1,2] 陈靖[1,2] 王准[1,2] 吴涛[1,2] 赵鹏[1,2] 权昌益[1,2] 牛远杰[1,2] 

机构地区：[1]天津医科大学第二医院泌尿外科 [2]天津市泌尿外科研究所天津市泌尿外科基础医学重点实验室,天津300211

出　　处：《现代泌尿外科杂志》2013年第2期169-171,共3页Journal of Modern Urology

摘　　要：目的探讨腹膜后纤维化致肾积水的诊疗方法,以提高本病早期诊断率。方法回顾性分析天津医大第二医院泌尿外科10年来收治的52例腹膜后纤维化致肾积水患者的临床资料。结果 52例中7例行膀胱镜或输尿管镜下置入双J管并口服激素+他莫昔芬治疗;45例行输尿管置管+输尿管松解术,其中11例一期输尿管置管,待肾功能改善后二期输尿管松解术。行输尿管松解术患者中,输尿管移入腹腔35例,带蒂大网膜包裹10例。术后病理检查诊断均为纤维脂肪组织伴炎性细胞浸润。随访1月～10年,52例术后临床症状均减轻或完全消失,肾功能均明显改善。结论对于B超检查提示肾积水患者,在排除输尿管占位、结石、肾盂输尿管连接部狭窄等常见疾病后要考虑到腹膜后纤维化的可能,并进一步行IVU、CT、输尿管镜等检查,以在术前明确诊断。治疗以解除输尿管梗阻,尽可能保护肾功能,减少复发为主要目的。Objective To explore the diagnosis and treatment of hydronephrosis caused by retroperitoneal fibrosis（RPF）,and to improve the rate of early diagnosis.Methods The clinical data of 52 cases of hydronephrosis caused by RPF treated in our hospital during the past 10 years were retrospectively analyzed.Results Double-J-catheter were placed in 7 cases under cystoscope or ureteroscope and these patients took glucocorticoid and tamoxifen at the same time.Ureterolysis and double-J-catheter were performed in 45 cases,11 of which had double-J-catheter placed at the first stage and underwent ureterolysis after renal function was improved.Of the 45 patients who received ureterolysis,35 had ureter moved to abdominal cavity,and 10 had the ureter enveloped with a piece of pediculated omentum.Pathological examination after surgery revealed fibrofatty tissue with inflammatory cell infiltration.During the follow-up of 1 month to 10 years,all 52 cases had clinical symptoms relieved renal function improved.Conclusions For patients with hydronephrosis identified by B ultrasound,calculus,neoplasm,ureteropelvic junction obstruction,retroperitoneal fibrosis and other diseases should be taken into consideration.Further examinations,such as IVU,CT and ureteroscopy are necessary to confirm the diagnosis before operation.The treatment for retroperitoneal fibrosis is mainly to relieve ureter obstruction,protect renal function and reduce recurrence.

关 键 词：腹膜后纤维化 肾积水 诊断 治疗 

分 类 号：R737[医药卫生—肿瘤]