肾淋巴管扩张症临床分析

Clinical analysis of renal lymphangiectasia

目的总结肾淋巴管扩张症的临床特点及治疗方法。方法分析2008年12月、2010年6月收治的2例肾淋巴管扩张症患者临床资料。例1，女，37岁。右腰腹部痛8d。B赳检查示双肾周混合性回声，与肾脏分界欠清。CT检查示奴。肾被膜下低密度影，内混有散在点状高密度影。保守治疗3周后疼痛缓解。3个月后右侧腰痛加重，CT检查示右肾周被膜下大量积液，B超引导下穿刺置管引流后积液消失；2个月后复查B超示左侧肾周少量积液，穿刺抽液后行积液常规及瘤细胞检查。例2，女，32岁。左腰部酸痛不适3年。B超检套示左肾周围不规则囊性病变，CT榆查示左肾后外侧分叶状囊性病变，与肾实质分界不清，左肾受压前移。诊断为左肾淋巴管瘤，硬膜外麻醉下行淋巴管瘤切除术。结果例1囊液涂片见大量淋巴细胞和少量中性粒细胞，考虑为淋巴液，临床诊断为肾淋巴管扩张症，随访2个月未见复发。例2术后病理检查囊壁衬以扁平上皮细胞伴淋巴细胞浸润，淋巴管呈囊状扩张，诊断为肾囊性淋巴管瘤。术后随访9个月末见复发。结论B超、CT检查有助于肾淋巴管扩张症的诊断，穿刺细胞学和组织病理学检查可确诊。无症状者可密切随访，有症状者可穿刺引流，但复发率较高；也可手术切除扩张淋巴管＋无水乙醇破坏内皮细胞治疗，复发率低，但可能发生淋巴漏。

Objective To discuss the characters and management of renal lymphangiectasia. Methods The clinical data of two cases of renal lymphangiectasia were reviewed. The first patient was a 37-year-old woman with the chief complaint of lumbago in the right flank for 8 days. B-ultrasound showed mixed echo in perinephric space. On CT, similar appearances of fluid collections were seen, but not conspicuous. Conservative treatment was taken for three weeks and the symptoms were relieved. Three month later the patient had right lumbago relapse. CT scan revealed a large amount of fluid collection under the capsule of the right kidney. Pereutaneous drainage was carried out. Two months later B-ultrasound stlowed fluid collection in perinephric space and percutaneous drainage again the fluid was sent to pathology. The second case was a 32-year-old woman with the chief complaint of lumbago in the left flank for the past three years. Ultrasonography revealed hypereehoic surrounding the left kidney. CT scan showed a left perinephric collection of fluid attenuation and circumferentially draping around the kidney. Renal lymphangioma was diagnosed and the patient underwent surgery. Results Needle aspiration of the perinephric fluid was carried out, and laboratory analysis showed most leucocytes were lymphocytes. The pathologic diagnosis of the first case was renal lymphangiectasia. There was no recurrence during follow - up of two months. The second case was diagnosed renal lymphangioma pathologically. Follow - up for nine years, revealed no relapse. Conclusions Ultrasonograpby and CT contributed to the diagnosis of renal lymphangiectasia. Needle aspiration bioposy and histology could confirm it. Treatment of asymptomatic cases is not required. When collections are very large and cause symptoms, percutaneous drainage may be carried out howeveT there is a risk of relapse.