腹膜后纤维化16例误诊分析

Misdiagnosis of Retroperitoneal Fibrosis in 16 Cases

目的分析腹膜后纤维化(retroperitoneal fibrosis, RPF)误诊原因,提高临床医生对本病的认识。方法回顾分析我院16例RPF误诊病例资料。结果 16例均以腰背部疼痛不适为主要症状,伴恶心、呕吐2例,血尿4例,伴肾区叩击痛11例,触及上腹部包块7例,伴腹胀6例,下肢水肿3例。CT扫描16例均见腹主动脉周围有低密度灶包裹,边界不清,6例累及髂血管,4例累及下腔静脉;8例腹主动脉管壁不规则增厚,正常结构消失,管腔轻度狭窄;10例出现肾积水,4例病变侵犯输尿管,病灶以上段输尿管明显扩张、包埋段输尿管显示不清;7例行增强CT扫描,病灶强化不明显或稍强化。误诊为腹主动脉大动脉炎8例、输尿管肿瘤及腹部包块性质待查各4例。16例均行手术治疗,经术中病理均诊断为RPF,予手术缓解输尿管梗阻及周围组织血管压迫,术后予抗生素、糖皮质激素等治疗后出院,随诊1年均未见复发。结论当临床遇及腰背痛、腹膜后组织肿物或不明原因出现尿路梗阻症状患者,CT检查发现有异常密度灶包绕腹膜后大血管,并伴肾积水、输尿管扩张征象时,应想到本病可能,及时行CT增强扫描,结合患者症状体征及相关检查结果,综合分析病情,仔细鉴别诊断,必要时可行手术病理检查明确诊断。

Objective To analyze the causes of misdiagnosis of retroperitoneal fibrosis(RPF) and to improve physicians’ understanding of the disease. Methods The clinical data of 16 cases of RPF misdiagnosed in our hospital was retrospectively analyzed. Results The main symptoms of all 16 cases were pain and discomfort in the lower back, including 2 cases with nausea and vomiting, 4 cases with hematuria,11 cases with percussion pain in the kidney,7 cases with upper abdominal mass, 6 cases with abdominal distension, and 3 cases with edema in the lower extremities. CT scans showed low-density lesions around the abdominal aorta in 16 cases, with unclear boundary, iliac vessels involvement in 6 cases, inferior vena cava involvement in 4 cases, irregularly thickened abdominal aorta wall, disappearance of normal structure, and slightly narrowed lumen in 8 cases, hydronephrosis in 10 cases, invasion of ureter in 4 cases, with obvious dilation in the segment of ureter above the lesion, and unclear embedded segment of the ureter. In addition, 7 cases underwent enhanced CT scan, and the enhancement of the lesion was not obvious or slightly enhanced. Therefore, 8 cases were misdiagnosed as abdominal aortitis, 4 cases as ureteral tumors and 4 cases as abdominal mass. Sixteen patients were scheduled to undergo surgical treatment, and were diagnosed as RPF by intraoperative pathology. Operations were performed to relieve ureteral obstruction and vascular compression in surrounding tissues. After treatment with antibiotics, glucocorticoids and other drugs, they were discharged from hospital. No recurrence was found at 1-year follow-up. Conclusion When patients presented with lower back pain, retroperitoneal tissue mass or unexplained urinary tract obstruction, and when CT examination showed abnormal density lesions surrounding large retroperitoneal blood vessels, accompanied by hydronephrosis and ureteral dilatation, this disease should be considered. Timely CT enhancement scan should be performed, coupled with the symptoms and signs of patients and related examination results, comprehensive analysis of the condition, careful differential diagnosis, and pathological examination, if necessary, to confirm the diagnosis.