下腔静脉后输尿管诊治分析

Analysis of Diagnosis and Treatment of Retrocaval Ureter

目的总结下腔静脉后输尿管的诊治经验。方法报告2例下腔静脉后输尿管误漏诊病例资料并复习相关文献。1例男性,70岁,以右腰腹痛就诊,术前诊断为右输尿管结石伴右肾中度积水。1例女性,17岁,以下腹包块就诊,术前诊断为卵巢浆液性囊腺瘤。结果2例均术中证实为下腔静脉后输尿管并行手术矫正,术后肾积水消失或减轻,肾功能正常或明显改善,吻合口无狭窄,无临床不适症状。结论下腔静脉后输尿管主要通过影像学检查明确诊断,提高对本病的临床认识是避免误漏诊的关键。输尿管离断复位吻合术是治疗下腔静脉后输尿管的主要术式。

Objective To summarize the experience of diagnosis and treatment of retrocaval ureter. Methods Two cases of retrocaval ureter were misdiagnosed before operation, in which one was a 70-year-old male presented lumbago and celialgia and diagnosed right lateral ureteral calculi with medium hydronephrosis, the other was a 17-year-old female complained lower-abdominal mass and diagnosed ovarian serous cystadeno- ma. The relevant literatures of retrocaval ureter were reviewed. Results Surgical correction was performed following the diagnosis of retrocaval ureter confirmed during operation. Hydronephrosis and renal function was recovery or improved without anastomotic stenosis and discomfort symptoms in both patients postoperatively. Conclusion The definite diagnosis of retrocaval ureter is mainly based on imaging examination. Improvement of clinical recognition of the disease is the key to avoid mis- and missed diagnosis of retrocaval ureter. Ureteral reduction after amputation and uretero-ureteral or uretero-pelvic anastomosis is the main surgical procedure for retrocaval ureter.