腹膜后纤维化致肾积水诊治策略

Diagnosis and treatment strategy of the retroperitoneal fibrosis associated with hydronephrosis

目的总结腹膜后纤维化（RPF）致肾积水的诊治策略。方法回顾性分析2005年1月至2012年3月26例RPF致肾积水患者的诊治资料。首发症状主要为腰腹痛、恶心、呕吐。B超检查发现腹膜后软组织肿块12例（46．2％，12／26），CT检查发现23例（88．5％，23／26）。结果10例行输尿管松解腹腔问置术，术后随访6～25个月，无复发；1例因输尿管松解困难行输尿管膀胱再植术，术后随访45个月，无复发；15例行双J管引流术，其中2例停止换管，其余间断换管，随访16～84个月，梗阻均得到缓减。结论腹部CT是发现腹膜后肿物的有效方法。治疗方法的选择应取决于肿物的病理状态，输尿管松解腹腔间置术与双J管引流术均能有效解除梗阻。换管期间的并发症可通过各种措施予以减轻或避免，复查时应注意健’肾的引流情况。

Objective To summarize the diagnosis and treatment strategy of the retroperitoneal fi- brosis （RPF） associated with hydronephrosis. Methods The clinical data of 26 RPF cases treated from Jan. 2005 to Mar. 2012 were analyzed retrospectively. Early symptoms mainly included lumbar, flank, ab- dominal pain, nausea and vomit. Retroperitoneal mass was found in 12 （46.2%） cases by ultrasonography, while in 23 （88.5%） cases by CT. Results Ureterolysis with intra-peritoneal transposition was under- went in 10 cases who were followed up for 6 - 25 months, and no relapse was found. Ureterocystostomy was underwent in 1 cases for difficulty in ureterolysis who was followed up for 45 months, and no relapse was found. D-J stent inter-ureter drainage was performed in 15 cases, all of whom had replaced the D-J stent dis- continuously except that 2 cases had ceased replacement successfully, and all of the obstruction were relieved during the follow-up period for 16 - 84 months post-operatively. Conclusions Retroperitoneal mass can be found by CT of abdomen effectively. The therapeutics should depend on the pathological condition of the retroperitoneal mass. Obstruction can be relieved effectively by both ureterolysis with intraperitoneal transpo- sition and D-J stent inter-ureter drainage and replacement. The complication occurred in the replacement of D-J can be relieved or eliminated by all kinds of measures. The unimpaired kidney drainage should be paid attention in the follow-up.