北京大学学报(医学版) ›› 2024, Vol. 56 ›› Issue (5): 913-918. doi: 10.19723/j.issn.1671-167X.2024.05.025
陈思鹭1, 王海菊1,2, 吴宇财1, 李志华1,2, 黄燕波1,2, 何宇辉1, 许洋洋1, 李学松1,*(), 贯华1,2,*()
Silu CHEN1, Haiju WANG1,2, Yucai WU1, Zhihua LI1,2, Yanbo HUANG1,2, Yuhui HE1, Yangyang XU1, Xuesong LI1,*(), Hua GUAN1,2,*()
摘要:
目的: 探究成人上尿路梗阻引起肾积水的病因分布,以提高其病因学诊断的准确性。方法: 连续前瞻性收集2020年5月至2021年5月北京大学第一医院上尿路修复专业门诊新诊治的767例成人肾积水患者的临床信息,排除输尿管结石、上尿路肿瘤患者,分析成人肾积水病因。患者的肾积水病因根据其症状、病史、体格检查、超声、计算机断层扫描(computed tomography, CT)、磁共振成像(magnetic resonance imaging, MRI)、逆行肾盂造影、顺行肾盂造影、放射性核素肾图、输尿管镜检查等综合判断。结果: 767例成人肾积水患者中男性359例(46.8%)、女性408例(53.2%),中位年龄37岁(范围14~84岁),左侧肾积水357例(46.6%)、右侧肾积水251例(32.7%)、双侧肾积水159例(20.7%)。病因分布如下:(1) 非医源性因素464例(60.5%),包括泌尿系统畸形355例(76.5%)、感染29例(6.3%)、盆腔脂肪增多症和(或)腺性膀胱炎23例(5.0%)、输尿管子宫内膜异位症18例(3.9%)、腹膜后纤维化15例(3.2%)、肾盂旁囊肿8例(1.7%)、外伤7例(1.5%),其他非医源性因素12例(2.6%),部分患者合并两种或两种以上非医源性病因。355例泌尿系统畸形的患者中,肾盂输尿管连接部狭窄252例(71.0%)。(2)医源性输尿管损伤210例(27.4%),其中泌尿外科操作损伤112例(53.3%),恶性肿瘤放疗损伤51例(24.3%),妇产科手术损伤34例(16.2%),普外科手术损伤13例(6.2%)。(3)原因不明的肾积水93例(12.1%)。结论: 成人上尿路梗阻引起肾积水的病因复杂多样,泌尿系统畸形和医源性输尿管损伤是导致成人肾积水的常见原因,从事上尿路修复工作的泌尿外科医生应熟悉每一种病因,以便明确诊断并选择出最合适的治疗方案。
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