腹膜后纤维化与肾积水发生关系的临床研究

Relationship between Retroperitoneal Fibrosis and Hydronephrosis and Its Diagnosis and Treatment

目的:探讨腹膜后纤维化(RPF)导致肾积水的原因及诊治经验。方法:回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果:(1)RPF患者常见首发症状为腰背痛或腹痛(69.2%);(2)红细胞沉降率(ESR)增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影(IVP)和CT尿路成像(CTU)表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例(37.5%),优于超声检查;(3)输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;(4)特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论:影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。

Objective：To investigate the etiology,diagnosis and treatment of hydronephrosis induced by retroperitoneal fibrosis（RPF）.Methods：The medical records of 24 patients with hydronephrosis induced by retroperitoneal fibrosis from January 2004 to December 2010 were reviewed.Results：（1） The most common initial symptom was flank,back,or abdominal pain（69.2%）.（2） Elevated erythrocyte sedimentation rate and high serum IgG4 were commom.Ultrasonography only showed hydronephrosis.Features of RPF in intravenous pyelography（IVP） and CT urography（CTU） were characteristic.As pelvis and ureter were poorly visualized by IVP,upper urinary tracts were well visualized by CTU.CT found retroperitoneal mass in 9 cases（37.5%）,which was better than ultrasonography.（3） Twenty-two cases were performed ureterolysis;1 case performed nephrectomy;1 case was inserted double-J ureteric stent.Finally,8 cases were identified secondary RPF,including 4 cases of preoperative diagnosis,3 cases of intraoperative diagnosis by frozen biopsy of retroperitoneal mass,and 1 case of postoperative pathology.（4） Hydronephrosis of idiopathic RPF was relieved after the surgical procedures,prognosis of secondary RPF was determined by primary disease and its treatment.Conclusions：Imaging examinations were main approaches to diagnose RPF,CTU was superior to ultrasonography and IVP.Ureterolysis provided long-term relief of ureteral obstruction of idiopathic RPF,intraoperative frozen biopsy of retroperitoneal mass benefited to differential diagnosis between idiopathic and secondary RPF and modified treatment.