输尿管十二指肠瘘1例报告并文献复习

目的:探讨输尿管十二指肠瘘的临床、病理特点及诊断处理。方法:回顾性分析1例输尿管十二指肠瘘患者的临床资料。患者,女,63岁,反复右侧腰痛,肉眼血尿1年。B超检查发现右侧输尿管上端占位,可疑输尿管肿瘤;CT示右侧肾黄色肉芽肿。逆行性造影肠道内显示造影剂,怀疑输尿管十二指肠瘘。肾核素扫描示右肾无功能,左肾功能好。术前诊断为输尿管十二指肠瘘。结果:手术采用经腹腔路径,术中见右肾与腰大肌粘连,瘘口位于上段输尿管与十二指肠降部之间,切除右侧肾脏后,修剪十二指肠瘘口,行上段空肠的Roux-Y吻合修补十二指肠瘘口。切开肾脏标本见瘘口位于距离肾盂2cm处上段输尿管。术后病理学检查在炎症组织中存在泡沫状巨噬细胞,诊断为肾脏黄色肉芽肿,术后恢复好,10d出院,随访1年患者健康,未述不适。结论:输尿管十二指肠瘘是一种罕见的疾病,正确的诊断非常重要,手术治疗效果好。

A case report of ureteroduodenal fistula and literature review

Objective:To explore the clinical,pathological characteristics,diangosis and management of Ureteroduodenal fistula.. Method:We presented a 63-year-old female with ureteroduodenal fistula caused by xanthogranulomatous pyelonephritis(XGP)who mainly complained of right flank pain,gross hematuria without lower urinary tract symptom.Retrograde urography found out ureteroenteric fistula 2cm distal to the ureteropelvic junction.Renal scintigraphy and intravenous urography showed that the function of right kidney was heavily damaged. Result:Nephrectomy was performed and Roux-Y procedure was used to repair the duodenal defect.The postoperative recovery was uneventful and discharged at 10th day postoperatively.Pathological result verified the diagnosis of XGP. Conclusion:Ureteroduodenal fistula is a rare entity in the urological practice,and its correct diagnosis is very important,the prognosis is good after operation.