北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (4): 552-557.

• 论著 • 上一篇    下一篇

造血干细胞移植后肾积水的病因及治疗

于路平,徐涛△,黄晓波,王晓峰   

  1. (北京大学人民医院泌尿外科,北京100044)
  • 出版日期:2014-08-18 发布日期:2014-08-18

Pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation

YU Lu-ping, XU Tao△, HUANG Xiao-bo, WANG Xiao-feng   

  1. (Department of Urology, Peking University People’s Hospital, Beijing 100044, China)
  • Online:2014-08-18 Published:2014-08-18

摘要: 目的:探讨造血干细胞移植后肾积水的病因及治疗选择。方法:回顾性分析2004年3月至2014年3月接受造血干细胞移植(hematopoietic stem cell transplantation,HSCT)并在HSCT后出现肾积水的23例血液病患者资料,采集患者年龄、性别、是否出现出血性膀胱炎(hemorrhagic cystitis,HC)、HC发生距离HSCT的时间、HC程度、是否并发输尿管炎、是否并发病毒血症、肾积水治疗方法、治疗效果等资料,结合病历资料总结并分析发生肾积水的原因。将患者根据是否需要外科干预分为两组,再根据是否发生输尿管狭窄行输尿管扩张分为两组,均应用秩和检验、确切概率法检验评估两组间在HC发生距离HSCT的时间、是否并发输尿管炎、是否并发病毒血症等方面的差异是否有统计学意义。结果:出血性膀胱炎、输尿管炎、输尿管瘢痕狭窄均会造成HSCT后肾积水。HSCT后患者中69.6%(16/23)经保守治疗后肾积水缓解,30.4%(7/23)经外科干预后缓解,其中13.0%(3/23)早期行膀胱镜留置内置输尿管支架管(DJ管)或肾造瘘术后缓解,17.4%(4/23)后期出现输尿管瘢痕狭窄,经输尿管球囊扩张后2例患者成功拔除DJ管,1例患者需长期留置DJ管,1例患者仍在随访中。秩和检验及确切概率法检验结果显示:需要外科干预的HSCT后肾积水患者相对于保守治疗者发生HC的时间更晚、输尿管炎和病毒血症发病率更高,但两组间差异均无统计学意义(P值分别为0.524、0.169、0.124)。发生输尿管瘢痕狭窄需输尿管扩张的HSCT后肾积水患者相对其他患者输尿管炎发病率更高,两组间差异有统计学意义(P=0.024);需输尿管扩张的患者相对于其他患者发生HC的时间更晚、病毒血症发病率更高,但两组间差异无统计学意义(P值分别为0.73、0.27)。结论:HC、输尿管炎、输尿管瘢痕狭窄均会造成HSCT后患者肾积水,早期可先行保守治疗,对于HC出现晚、合并病毒血症、尤其是有输尿管炎的肾积水患者应密切随访,必要时可行膀胱镜DJ管置入或肾造瘘术等外科方式治疗,对于输尿管瘢痕狭窄的患者可行输尿管球囊扩张治疗。

关键词: 造血干细胞移植, 肾盂积水, 膀胱炎, 输尿管梗阻

Abstract: Objective:To investigate the pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation (HSCT). Methods: From March 2004 to March 2014, 23 patients with hydronephrosis after HSCT were identified. With these data, the pathogenesis of hydronephrosis after HSCT were analyzed. According to the surgical intervention of hydronephrosis and ureteral dialation of ureteral stricture, the patients were divided into two groups, ranksum test and exact probability test were used to evaluate whether there were significant differences in the time of hemorrhagic cystitis (HC) occurred, ureteritis and viremia. Results: HC, ureteritis, ureteral stenosis were all the causes of hydronephrosis after HSCT. In this study, 69.6% (16/23) of the patients suffered from HSCT were cured by conservative treatment, 30.4% (7/23) by surgical intervention, and 13.0% (3/23) by insertion DJ stent or nephrostomy.Of the patients [17.4% (4/23)] who suffered ureteral stenosis, 2 were cured after the balloon dialation of ureter, 1 needed DJ tube longterm insertion, and 1 was still followed-up. Rank-sum test and exact probability test results showed that the patients who needed surgical intervention might suffer from HC later than other patients, and their incidences of viremia and ureteritis were higher, but the differences between the two groups were not statistically significant (P=0.524, P=0.169, and P=0.124, respectively). The results also showed that the ureteritis incidences of the patients who suffered from ureteral stricture and needed ureteral dialation were higher than that of the other patients, and the difference between the two groups was statistically significant (P=0.024). The patients who needed ureteral dialation suffered from HC later and their incidences of viremia was higher, but the differences between the two groups were not statistically significant (P=0.73 and P=0.27). Conclusion: HC, ureteritis and ureteral stenosis may cause hydronephrosis after HSCT. Patients may treated by conservative treatment first. Patients who suffered from HC later, viremia and especially ureteritis should be paid more attention to, and be treated with surgical intervention when necessary. The patients with ureteral stenosis could be treated by ureteral balloon dialation.

Key words: Hematopoietic stem cell transplantation, Hydronephrosis, Cystitis, Ureteral obstruction

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