重复肾合并肾积水误诊为肾囊肿临床分析

Duplex Kidney Misdiagnosed as Renal Cysts

目的探讨重复肾合并肾积水与肾上极较大囊肿的鉴别诊断。方法分析2005年1月—2010年4月我院收治外院将重复肾合并肾积水误诊为肾囊肿的4例患者的影像学资料、实验室检查结果,并对相关文献进行复习。结果本组4例患者均于外院诊断为肾囊肿,1例转入我院后行逆行造影时发现输尿管口数目异常,明确诊断,给予膀胱输尿管移植后治愈;1例入院后行CT成像示右肾重复肾、巨输尿管症,给予腹腔镜重复肾上半肾及巨输尿管切除术后治愈;另外2例于外院行腹腔镜"囊肿去顶减压术"后引流液较多,不能拔出引流管而来我院就诊,经检查确诊为重复肾,其中1例行重复肾上半肾切除,另外1例行膀胱输尿管移植后治愈。结论对于重复肾合并肾积水的患者,术前除应做详细的实验室检查外,必要时行输尿管镜、逆行造影等有创检查,以明确诊断,避免盲目手术造成的严重后果。

Objective To investigate the differential diagnosis between duplex kidney with hydronephrosis and large renal cysts. Methods Imaging data and laboratory data of 4 cases of duplex kidney complicated with hydronephrosis treated by our hospital between January 2005 and April 2010 who had been misdiagnosed as renal cysts by other hospitals were ana- lyzed. Relevant literatures were reviewed. Results All 4 patients studied were misdiagnosed as renal cysts by other hospitals. One case was diagnosed by retrograde contrast after abnormal number of ureteral orifices was noted; the patient was cured after vesico -ureteral transplantation. One other case was described by CT imaging as ＂ duplicated right kidney＂ with megaureter and was cured by laparoscopic heminephroureterectomy; the other two cases were hospitalized because of unstoppable drainage after lapa- roscopic ~＇ cyst decortieation ＂ performed by other hospitals and were cured by upper pole partial nephrectomy and transplantation of ureter respectively after diagnosed as duplex kidney. Conclusion Aside from detailed routine laboratory examinations, inva- sive examinations such as preoperative ureteroscopy and antegrade pyelography are more often than not necessary so as to avoid the serious consequences of boldness operations with inadequate consideration.