腹膜后纤维化1例及近年国内文献报告106例临床分析

Retroperitoneal fibrosis, 1 case reported and analysis of 106 cases in China
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    摘要:

    目的 了解我国腹膜后纤维化(retropeitoneal fibrosis,RPF)的临床特点及探讨RPF早期诊断标志.方法 回顾性分析本院1例RPF及国内杂志发表有关文献共20篇,总计106例的临床资料.结果 男性多于女性(2.9:1),年龄20~84岁,平均(50.9 ±10.3)岁;首发症状:腹、腰背痛(66/107),尿路梗阻(19/107);体征:下肢水肿(13/107),腹部包块(9/107),发热(2/107),腹水(1/107);影像学检查:B超、IVP、CT发现肾盂积水和输尿管上段扩张(78/107),CT、MRI发现腹部肿块、脏器黏连、病变范围(79/107);治疗方案:炎症早期内科激素取得理想效果(5/50);晚期纤维化均需外科治疗(39/50),部分病人结合内科治疗(6/50).结论 我国RPF发病男性多于女性,以中年为主;起病隐匿,无特异性,临床症状主要为腹、腰背痛,尿路梗阻;体征主要有下肢水肿、腹部包块;影像学检查对RPF的早期诊断及鉴别诊断有重要价值;早期应用糖皮质激素或联合免疫抑制剂治疗效果较好;晚期出现器官压迫和梗阻时需手术和(或)介入治疗,配合糖皮质激素治疗可以减少复发.

    Abstract:

    Objectives To analysis the clinical features of retroperitoneal fibrosis (RPF) in China, and to investigate the early diagnostic signs of RPF. Methods We retrospectively analyzed the clinical data of 107 RPF patients ,including lease in our hospital and 106 cases reported in other hospitals in China. Results The inci-dence of RPF in male was higher than that in female (2.9 : 1), the age was from 20 to 84 years old, averaged (50. 9 ±10.3). The initial symptoms of RPF: abdominal pain, notalgia were found in 66 patients (61.7%), urinary tract obstruction 19 patients(17.8%). Physical signs: swollen leg, abdominal mass, fever, ascites were found in 13 patients(12. 1%), 9 patients(8.4%), 2 patients(1.9%), 1 patient(0.94%), respectively. Imaging examination is very important: there were 78 cases(72.9%) of renal hydrocele or upper ureter pathological found by B mode ul-trasonography, IVP or CT; 79 cases (73.8%) of abdominal mass, organ adhenaiou were found by CT and MRI. Curative effect was relation with developmental phase and degree of RPF. Use of glucocorticoid was essential in in-flammation; When fibrosis was formed and tanned to obstruction, it should be operated in time. Conclusions The incidence of RPF was higher in male than in female, mainly in middle -aged. The initial syrup toms of RPF are not specific, including abdominal pain, antalgia , waist pain, urinary tract obstruction,leg edema, abdominal mass, Image examination is very important in diagnosis and differential diagnosis. The direct of Glucocorticoid and (or) im-munosuppreasant is good in the early stage. While,in the late stage, surgery and(or) intervention is needed to treat organ oppression and obstruction. Besides, Glucocorticoid is still needed to reduce the relapse rate.

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引用格式: 孟宇俊,吴家斌,魏立新.腹膜后纤维化1例及近年国内文献报告106例临床分析[J].国际泌尿系统杂志,2010,(2).

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