腹膜后纤维化致肾积水的诊治分析

目的探讨腹膜后纤维化（RPF）致肾积水的诊断与治疗方法，以提高本病的早期诊治率。方法回顾性分析1998～2008年间所收治的5例腹膜后纤维化致肾积水患者的临床资料，其中原发性者3例，继发性者2例；通过影像学检查进行诊断和鉴别诊断；1例行双侧输尿管内支架管＋他莫昔芬治疗，1例给予糖皮质激素治疗，3例行输尿管松解术或输尿管松解加大网膜包裹术并于术前、术后加用激素治疗。结果随访3—48个月，1例继发于胃癌者于术后3个月死亡；4例治疗后血沉降至正常，肾积水基本消失或明显减轻，随访期间未见复发。结论对于不明原因的肾积水患者，应考虑到RPF的可能；B超、CT、MRI、逆行肾盂造影等检查对RPF的诊断和鉴别诊断有重要价值；早期病变可给予药物治疗，中晚期病变以手术治疗为主；血沉可作为判断疾病活动和治疗效果的指标。

The study of hydronephrosis caused by retroperitoneal fibrosis

Objective: To investigate the diagnosis and treatment of hydronephrosis caused by retroperitoneal fibrosis. Methods: A retrospective study from 1998 up to 2008, for the diagnosis and treatment of 5 cases of hydronephrosis caused by retroperitoneal fibrosis was made. Results: One patient secondary to malignancy died in 3 months after operation. The other patients were followed up for 3 to 48 months with the involved kidneys normal in size and shape. Conclusion: Retro-peritoneal fibrosis should be considered in hydronephrosis without agent. B mode uhrasonography, CT , MRI and retrograde urogram are very important in the diagnosis. Drug therapy is only used in the early stage of RPF, while surgical therapy should be resorted for advanced disease.