论文部分内容阅读
目的探讨输尿管肿瘤导致肾盂输尿管自发性破裂的临床诊治特点。方法总结4例输尿管下段肿瘤导致肾盂输尿管自发性破裂患者的临床资料。4例中男、女各2例,年龄56～72岁。突发腰痛起病3例,突发右上腹痛伴休克1例;4例CT扫描均有肾盂积水及输尿管近端扩张,3例CT平扫显示肾周积液,增强扫描提示积液中造影剂外溢,1例合并尿毒症患者超声显示腹膜后巨大血肿。结果3例行一侧肾输尿管全长切除术,1例先行输尿管下段狭窄段探查切除,病理证实为高级别尿路上皮癌,1周后行肾输尿管全长切除术。4例患者均经病理证实为尿路上皮癌。2例术后行局部放疗,1例放疗结束后接受吉西他滨化疗。CT随访6～24个月,3例未见局部复发及转移,1例术后3个月出现局部复发及全身多发转移,8个月时死于全身脏器衰竭,恶液质。结论肾盂输尿管自发破裂临床少见,输尿管肿瘤所致上尿路梗阻是其病因之一,根治性手术为首选治疗方式。
Objective To investigate the clinical diagnosis and treatment of ureteropelvic ureter spontaneous rupture. Methods The clinical data of 4 patients with spontaneous rupture of ureteropelvic ureter caused by lower ureteral tumors were summarized. 4 cases of male and female in 2 cases, aged 56 to 72 years. Sudden onset of back pain in 3 cases, sudden right upper quadrant pain and shock in 1 case; 4 cases of CT scan with hydronephrosis and ureteral proximal expansion, 3 cases of CT showed perinephric effusion, enhanced scan prompted effusion in the contrast Agent spillage, 1 case of uremic patients showed retroperitoneal large hematoma ultrasound. Results Three patients underwent partial nephroureterectomy and one case underwent primary ureteral stenosis. The pathology was confirmed as high grade urothelial carcinoma and one week later, total nephroureterectomy was performed. All 4 patients were pathologically confirmed as urothelial carcinoma. Two patients underwent local radiotherapy and one received gemcitabine chemotherapy after the end of radiotherapy. CT was followed up for 6 to 24 months. No local recurrence and metastasis were found in 3 cases. Local recurrence and systemic multiple metastasis occurred in 1 case 3 months after operation, and died of systemic organ failure and cachexia at 8 months. Conclusions Spontaneous rupture of ureteropelvic ureter is rare, and urethral obstruction caused by ureteral tumor is one of the etiologies. Radical surgery is the first choice of treatment.