尿路梗阻后自发性肾周尿外渗23例分析  

Analysis of 23 cases of spontaneous perirenal urine extravasation after urinary tract obstruction

作　　者：马沛莉 代海涛[1] 张忠 刘远华[1] 郭培超 胡振兴 彭昌伟 MA Peili;DAI Haitao;ZHANG Zhong;LIU Yuanhua;GUO Peichao;HU Zhenxing;PENG Changwei(Department of Urology,The First Affiliated Hospital of Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学附属第一医院泌尿外科,湖北荆州434000

出　　处：《现代泌尿外科杂志》2024年第10期865-868,共4页Journal of Modern Urology

摘　　要：目的探讨尿路梗阻后自发性肾周尿外渗的临床表现和诊治经验,提高对该疾病的认识。方法回顾性分析2018年—2020年长江大学附属第一医院收治的23例尿路梗阻后自发性肾周尿外渗患者的临床资料,对其原发疾病、临床表现、影像学检查、治疗方法及预后进行分析,总结尿路梗阻后自发性肾周尿外渗的诊治要点。结果23例尿路梗阻后自发性肾周尿外渗患者中男性15例、女性8例,平均年龄43.4岁,均通过B超、计算机断层扫描尿路造影、计算机断层扫描等影像学检查确诊。3例输尿管结石患者直接行输尿管镜碎石术,4例患者先行输尿管逆行置管、13例患者先行经皮肾穿刺造瘘术,之后均根据病情行二期手术治疗。3例肿瘤转移患者均首选输尿管逆行置管,2例成功,1例失败改行B超定位下肾穿刺造瘘引流术。结论尿路梗阻后自发性肾周尿外渗行尿路造影检查可明确诊断,可先采用输尿管逆行置管或经皮肾穿刺造瘘再行二期手术治疗尿路梗阻原发病。Objective To investigate the clinical manifestations and explore the experience of diagnosis and treatment of spontaneous perirenal urine extravasation after urinary tract obstruction so as to improve the understanding of the disease.Methods The clinical data of 23 patients with spontaneous perirenal urine extravasation after obstruction treated at our hospital during 2018 and 2020 were retrospectively analyzed,including the primary diseases,clinical manifestations,imaging examination,treatment and prognosis.The key points of diagnosis and treatment were summarized.Results Of the 23 patients,there were 15 males and 8 females,with an average age of 43.4 years.These cases were diagnosed by imaging tests such as ultrasound,computed tomography urography(CTU)and CT.Ureteroscopic lithotripsy was performed in 3 patients with ureteral calculi,retrograde ureteral catheterization in 4 patients and percutaneous nephrostomy in 13 patients.Afterwards,a second phase surgery was performed based on the patients condition.Of the 3 patients with tumor metastasis who underwent retrograde ureteral catheterization,2 operation were successful,and 1 operation failed and then converted to nephrostomy and drainage under B-ultrasound localization.Conclusion CTU should be performed as soon as possible to make a definite diagnosis.Treatment can be achieved with ureteral retrograde catheterization or percutaneous nephrostomy to achieve local decompression,followed by secondary surgery to treat the primary cause of obstruction.

关 键 词：尿路梗阻 自发性尿外渗 计算机断层扫描尿路造影 上尿路结石 经皮肾穿刺造瘘术 

分 类 号：R691.2[医药卫生—泌尿科学]