肾盏憩室临床误诊分析  

Clinical Misdiagnosis Analysis of Renal Calyceal Diverticulum

作　　者：邹义华[1] 李静[1] 张威[1] ZOU Yihua;LI Jing;ZHANG Wei(Department of Urology,the First People's Hospital of Chenzhou,Chenzhou,Hunan 423000,China)

机构地区：[1]郴州市第一人民医院泌尿外科,湖南郴州423000

出　　处：《临床误诊误治》2025年第9期33-36,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨肾盏憩室的临床特点、误诊原因及防范措施。方法 回顾性分析2021年6月收治的1例术前误诊为单纯性肾囊肿的肾盏憩室患者的临床资料。结果 因“体检发现左肾囊性肿物1周”入院,CT增强排泄期扫描未见造影剂进入囊腔,术前诊断为单纯性肾囊肿,行肾囊肿去顶减压术时抽取囊液行蛋白定性试验为阴性,静脉注射20 mg呋塞米,降低气腹压至5 mmHg,检查囊腔底部发现清亮液体自憩室颈口流出,改行肾盏憩室颈切开+憩室裁剪术,组织病理学检查证实为肾盏憩室。术后康复出院,误诊时间为2 d。随访3年患者无不适症状,肾盏憩室体积明显缩小。结论 肾盏憩室缺乏特异性临床表现,易误诊为单纯性肾囊肿,CT增强延迟60 min排泄期扫描是诊断肾盏憩室较好的检查方法,但仍存在假阴性可能,囊液蛋白定性试验、囊液肌酐定量检测可作为术中识别肾盏憩室的有效补救措施。Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of calyceal diverticulum(CD).Methods The clinical data of a patient with CD who was misdiagnosed as simple renal cyst before operation and admitted to hospital in June 2021 were retrospectively analyzed.Results The patient was admitted to hospital due to "left renal cystic mass found in physical examination for 1 week",and no contrast agent was found to enter the cystic cavity during the excretory phase of enhanced CT scan.He was diagnosed as a simple renal cyst before operation.The cyst fluid was extracted during renal cyst decompression for qualitative protein test,which was negative,and 20 mg furosemide was injected intravenously to reduce pneumoperitoneum pressure to 5 mmHg.Examination of the bottom of the cystic cavity showed clear fluid flowing from the neck of the diverticulum,and the operation was changed to cervical incision of CD and diverticulectomy.The histopathological examination confirmed the presence of CD.The patient was discharged from hospital after recovery from the operation.The misdiagnosis lasted 2 d.After 3 years of follow-up,the patient showed no discomfort symptoms and the volume of CD decreased significantly.Conclusion CD lacks specific clinical manifestations and is easily misdiagnosed as simple renal cyst.Contrast-enhanced CT with a delayed 60-min excretory phase scan is a good diagnostic method for CD,but there is still a possibility of false negativity.Qualitative test of cyst fluid protein and quantitative detection of cyst fluid creatinine can be used as effective remedies for identifying CD during operation.

关 键 词：肾盏 憩室 误诊 肾囊肿 囊液蛋白定性试验 囊液肌酐定量检测 病理学 

分 类 号：R692[医药卫生—泌尿科学]