泌尿系包虫囊肿的诊断及外科治疗

Clinical features, diagnosis and surgical treatment of urinary echinococcosis

目的探讨泌尿系包虫囊肿的临床特点和诊治要点。方法1956-2005年共收治泌尿系包虫囊肿患者27例。男21例,女6例。年龄3～53岁,平均35岁。腰部胀痛5例、腰腹部包块5例、发热2例、尿中排出白色小圆囊及白色粉皮样物1例、轻度肉眼血尿1例、进行性排尿困难4例、因其他疾病体检中发现9例。27例分别行B超、IVU、CT和膀胱镜检或造影检查。单囊型21例,其中破入肾盂2例,多子囊型6例。包虫囊肿直径7．0～13．8cm。行内囊摘除术19例,其中2例破入肾盂者置入双J管。内囊完整摘除2例、肾切除2例、膀胱后壁全外囊切除2例,2例膀胱直肠陷窝内包虫行内囊摘除,外囊壁纤维化部分剪除后,内翻缝合闭死囊腔。结果27例患者术后均痊愈出院,未出现任何并发症,病理检查均为细粒棘球蚴病。22例随访3～9年,包虫囊肿无复发。结论泌尿系包虫病囊肿诊断主要依据典型的临床表现、Casoni试验、B超、IVU、CT及膀胱镜等辅助检查。手术摘除包虫内囊是目前惟一有效的治疗方法,但应根据囊肿大小、位置和产生的不同病况确定手术方案。

To investigate the clinical features,diagnosis and treatment of urinary hydatid cyst,also known as echinococcosis. Methods Overall,27 cases （21 males and 6 females;age range,3-53 years;mean age, 35 years） of urinary hydatid cyst were treated from 1956 to 2005. Of these patients,5 had flank mass;5 had flank bulgy pain;2 had fever; 1 had a small white rounded cyst and something like gelatin in the urine; 1 had mild gross hematuria; 4 had progressive dysuria; and 9 were found to have urinary hydatid cyst incidentally in physical examination of other diseases. All the 27 cases underwent β-ultrasound, CT, IVU and cystoscopy. Of them, 21 cases had simple cyst and 6 had multiple cysts. The diameter of hydatid cyst was 7.0-13.8 cm. Extirpation of the internal cyst was performed in 19 cases （of them,2 had double-J catheter placement due to the cyst rupture into the renal pelvis）. Total extirpation of internal cyst was performed in 2 ; nephrectomy was performed in 2 ; total extirpation of external cyst with posterior wall of the bladder was performed in 2 ;and 2 cases who had hydatid inside rectal pouch underwent extirpation of internal cyst, partial resection of fibrotic external cyst wall and closing the cyst cavity by inverting suture. Results All the 27 patients were cured completely without complications. Pathology confirmed the diagnosis of echinococcosis in all cases. Follow-up was 3 to 9 years in 22 patients with no recurrence of hydatid cyst. Conclusions The diagnosis of urinary hydatid cyst depends on the typical clinical presentation, Casoni test and image findings of B-ultrasound, IVU,CT and cystoscopy. The only effective therapy is extirpation of internal cyst by open surgery.