药物结晶导致的急性双侧输尿管梗阻性无尿的诊断和微创治疗

Diagnosis and minimally invasive treatment of acute anuria caused by bilateral ureteral obstruction due to medicine crystal deposition

目的总结药物结晶导致的双侧输尿管梗阻性无尿的诊断和微创治疗经验。方法回顾性分析2例药物结晶导致的急性双侧输尿管梗阻性无尿患者的临床资料。结果 2例患者均于点滴抗生素后出现无尿、腰部疼痛、血肌酐水平升高,B超和KUB平片均不能明确诊断;64排CT平扫双侧输尿管下段可见稍高密度阴影,最大密度投影(MIP)显示输尿管下段高密度阴影,CT值为30～128Hu;1例行输尿管镜检查;1例行膀胱镜检查,2例术中放置双J管后即解除梗阻。B超随访2个月无肾积水,肾功能良好。结论药物结晶导致的双侧输尿管梗阻,传统的B超和KUB检查不能明确诊断,64排CT平扫双侧输尿管以及扫描后的MIP成像可以帮助明确诊断;行输尿管镜下或膀胱镜下放置双J管,可以达到积极治疗目的。

【Objective】To summarize the experience of diagnosis and minimally invasive treatment on acute anuria caused by bilateral ureteral obstruction due to medicine crystal deposition.【Methods】Two patients with acute anuria caused by bilateral ureteral obstruction due to medicine crystal deposition were treated,and the clinical data were reviewed.【Results】The main clinical manifestations consisted of anuria after injection of antibiotic,pain in renal region,high levels of creatinine.The main adjuvant examinations included B-ultrasound,X-ray （KUB） and noncontrast 64-row helical CT.The upper urinary tract obstructions were detected by B-ultrasound and CT.Neither were diagnosed definitively by B-Ultrasound and X-ray （KUB）.CT detected the slightly-high density image in the lower ureter.Maximum intensity projections （MIP） showed the slightly-high density image in the lower ureter clearly,and their CT values were 30～128 Hu;upper urinary tract obstructions were removed in both cases by ureteroscopic or cytoscopic part medical crystal removal and being placed double J stents,renal function recoved to normal rapidly postoperative in both cases and were normal two monthes later.【Conclusions】In patients with obstructive anuria caused by bilateral ureteral obstruction due to medicine crystal deposition,conventional KUB and US could not identify the cause of ureteral obstruction,but noncontrast 64-row helical CT MIP reconstruction could produce clear and comprehensive images of medicine crystal in the lower uerter,and could provide the diagnosis.The minimally invasive treatments including ureteroscopic or cytoscopic part medical crystal removal and placing double J stent are active treating methods.