尿路结石相关自发性非创伤性肾出血临床特征及治疗方式的选择  

Clinical features and treatment options of Wunderlich syndrome associated with urinary calculi

作　　者：卢东明 叶树朝 廖尚范 吴用样 谢雪萍 LU Dongming;YE Shuchao;LIAO Shangfan;WU Yongyang;XIE Xueping(Department of Urology,Affiliated Sanming First Hospital,Fujian Medical University,Sanming 365000,China)

机构地区：[1]福建医科大学附属三明第一医院泌尿外科,福建三明365000

出　　处：《现代泌尿外科杂志》2022年第11期903-906,931,共5页Journal of Modern Urology

基　　金：福建省自科科学基金(No.2019J01588);三明市科技计划项目(No.2017-S-3);福建医科大学启航基金项目(No.2019QH1258)。

摘　　要：目的探究尿路结石相关自发性非创伤性肾出血(WSUC)的临床特征以及治疗方式的选择。方法回顾分析福建医科大学附属三明第一医院2013年5月—2021年12月收治的8例WSUC患者的临床资料,并结合文献进行分析总结。结果患者平均年龄65.6岁,女性发病多于男性;以腰痛、发热为主要症状,常常伴有严重的全身性感染症状;常合并糖尿病和高血压等基础疾病;血、尿及脓液培养能够检测出致病菌,CT可见肾包膜下积液。所有患者均行经皮肾包膜穿刺引流,12.5%的患者行患肾切除术、12.5%的患者行肾包膜切开引流术、75.0%的患者尿路结石可以通过微创治疗;87.5%的患者经过积极治疗可治愈。结论WSUC是危及生命的紧急罕见情况,有效的抗感染及充分的引流是治疗该病的关键。尿路结石的内镜处理是WSUC有效可行的方式,采用何种手术方式需经个体化诊疗决定。Objective To investigate the clinical features and treatment options of Wunderlich syndrome associated with urinary calculi(WSUC).Methods Clinical data of 8 WSUC cases treated in our hospital during May.2013 and Dec.2021 were retrospectively analyzed and relevant literature was reviewed.Results The average age of patients was 65.6 years,and the incidence was higher in female than in male.Lumbago and fever were the main symptoms,frequently accompanied with severe symptoms of systemic infection.Diabetes and hypertension were common concomitant diseases.Culture of blood,urine and pus could detect pathogenic bacteria,and CT indicated subcapsular fluid in the kidney.Percutaneous renal capsule puncture and drainage were performed in all patients,including nephrectomy in 12.5%cases,renal capsule incision and drainage in 12.5%cases,and minimally invasive therapy in 75.0%cases.Up to 87.5%cases were healed after active treatment.Conclusion WSUC is a rare and life-threatening emergency,and effective anti-infection and adequate drainage are key to its treatment.Endoscopic management of urinary calculi is an effective and viable method for WSUC.The surgical method needs to be individualized.

关 键 词：自发性非创伤性肾出血 尿路结石 肾包膜下积脓 肾包膜下血肿 肾周脓肿 

分 类 号：R692[医药卫生—泌尿科学]