梗阻后自发性肾周尿外渗的临床分析

Clinical analysis of spontaneous urine extravasation in the perinephric space with urinary tract obstruction

目的 探讨梗阻性后自发性肾周尿外渗的临床特点、发病机理及治疗方法.方法 回顾性分析北京协和医院2008年至2012年收治的28例梗阻后自发性肾周尿外渗的临床资料,总结临床表现、影像学特点,探讨梗阻后自发性肾周尿外渗的诊断和治疗方法.结果 28例患者均无明显外伤史、剧烈活动史,其中男13例,女15例,年龄20～82岁,平均57.6岁.临床表现：腰腹痛26例（92.9％）,18例（64.3％）有发热,11例（39.3％）有恶心或呕吐,10例（35.7％）有下尿路刺激症状,8例（28.6％）肉眼血尿,5例（17.9％）伴有腹胀.22例（78.6％）有白细胞及中性粒比值升高.CT泌尿系成像（CTU）表现为患肾积水,肾周积液.病因诊断,其中10例（35.7％）为输尿管结石;8例（28.6％）为输尿管内肿瘤;4例（14.3％）为输尿管外肿瘤;其他少见病因6例（21.4％）.治疗上,7例（25％）轻度尿外渗,查明原因后直接处理原发病.21例（75％）重度尿外渗,先放置猪尾巴管（D-J管）或肾穿刺造瘘引流,待感染控制及肾功能有所改善后再处理原发病.结论 根据发热、腰痛等临床表现,结合超声、CT检查可帮助诊断.治疗上,对因治疗,处理原发疾病,尽快解决梗阻.

Objective To explore the clinical features, pathogenesis and treatment of spontaneous obstructive urinary extravasation. Methods Retrospective analysis of 28 cases of obstructive spontaneous urinary extravasation from 2008 to 2012, summarize clinical manifestations, imaging features, explore the diagnosis and treatment of obstructive spontaneous urinary extravasation. Results All 28 patients had no significant injury history and history of acuteness activity, including 13 males and 15 females, aged 20 ～ 82 years old, average 57. 6 years. Clinical mani- festations include： lumbar pain 26 cases （92.9%）, 18 cases （64. 3% ） had fever, 11 cases （39. 3% ） had nause- a or vomiting, 10 cases （35.7%） had urinary irritation symptoms, 8 cases （28.6%） with macroscopic haematuri- a, 5 cases （ 17.9% ） with abdominal distention. 22 cases （78.6%） routine blood leukocyte and neutral grain ratio increases. CTU performance with hydronephrosis, perirenal fluid. Etiology diagnosis, including 10 cases （35.7%） for ureteral calculi; 8 cases （28.6%） for ureteral tumor; 4 cases （14.3%） for ureteral tumor; Other rare causes of 6 cases （21.4%）. Conclusions According to the clinical manifestations such as fever, lumbago, combinedwith ultrasonic and CT can help diagnosis. Find out the cause of urinary extravasation, then treat the primary disease, obstruction should be settled as soon as possible.