特殊类型肾囊性疾病误诊误治临床分析  

Clinical Analysis of Misdiagnosis and Mistreatment of Special Types of Renal Cystic Disease

作　　者：杨旭东 张勇[1] YANG Xu-dong;ZHANG Yong(Department of Urology,Beijing Titan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院泌尿外科,北京100070

出　　处：《临床误诊误治》2021年第7期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：北京市医院管理中心“登峰”人才培养计划(DFL20190502)。

摘　　要：目的探讨特殊类型肾囊性疾病误诊误治原因及预防补救措施。方法对2017-2020年收治的曾误诊误治的特殊类型肾囊性疾病4例的临床资料进行回顾性分析。结果4例分别因超声检查发现双肾囊肿3年、CT检查发现左肾囊肿1年、超声检查发现左肾囊肿20 d和超声检查发现左肾囊肿11 d入院。术前CT尿路造影检查均提示肾囊性疾病。1例术前诊断双肾单纯性肾囊肿(BosniakⅠ级),术后确诊复杂肾囊肿(BosniakⅡ级),手术失当,造成大出血及尿瘘,行输尿管支架管置入术后好转;1例肾上盏扩张积液误诊为肾囊肿,置入输尿管支架管后转归良好;1例肾盏憩室合并结石误诊为肾囊肿伴钙化,术中缝合肾盏憩室交通口并置入输尿管支架管后转归良好;1例为肾囊肿,手术失当致手术困难,造成术程延长。结论完善术前相关检查和选择最优手术方案对避免肾囊性疾病的误诊误治具有重要意义。Objective To investigate reasons for misdiagnosis and mistreatment of special types of renal cystic diseases and to discuss preventive and remedial measures.Methods Clinical data of 4 patients with special types of renal cystic disease who were misdiagnosed and mistreated from 2017 to 2020 was retrospectively analyzed.Results The four patients were hospitalized because of bilateral renal cyst for 3 years detected by ultrasound examination,left renal cyst for 1 year by CT scan,left renal cyst for 20 d and 11 d by ultrasound examination respectively.Furthermore,preoperative CT urography examination revealed renal cystic disease in all patients.The first patient was diagnosed as having simple renal cyst of both kidneys(BosniakⅠ)before operation,and complex renal cyst(BosniakⅡ)was confirmed after operation,and massive hemorrhage and postoperative urinary fistula were found by improper operation,which were improved after ureteral stent placement.The second patient with dilatation effusion of the suprarenal calyx was misdiagnosed as having renal cyst,and the patient had a good treatment outcome after placement of a ureteral stent.The third patient with renal calyx diverticulum complicated with calculus was misdiagnosed as having renal cyst associated by calcification,and the patient had a good treatment outcome by suturing the communication opening of renal calyceal diverticulum and placing a ureteral stent intraoperatively.Moreover,the fourth patient with renal cyst underwent an improper operation which had caused increase of surgical difficulty and prolonged operation time.Conclusion Performing thorough preoperative examinations and choosing the most optimal surgical plan are of great significance to avoid misdiagnosis and mistreatment of renal cystic disease.

关 键 词：肾疾病 囊性 误诊 误治 

分 类 号：R692.12[医药卫生—泌尿科学]