多囊肾自发性破裂出血合并同侧输尿管结石一期手术处理1例并文献回顾
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摘要
目的探讨多囊肾自发性破裂出血合并同侧输尿管结石的临床特点、治疗及预后。方法报告1例多囊肾自发性破裂出血合并同侧输尿管结石,并结合文献进行讨论。结果术前根据相关检查、结合病史及入院查体诊断多囊肾伴囊内出血合并左侧输尿管结石,行后腹腔镜下左肾探查,见腹膜后巨大血肿为胶冻状深暗色血凝块,血肿壁厚且与周围组织广泛粘连,改行经左腰部开放手术清除血肿,同时行左输尿管切开取石术。结论多囊肾病程长,预后不佳,较大囊肿容易合并囊内出血及感染所致肾周广泛粘连,囊肿减压可改善症状并延缓病程进展。少量囊内出血可行保守治疗,多囊肾伴巨大血肿合并输尿管结石患者可同期行开放手术治疗。
Objective To explore the clinical characteristics, treatment and prognosis of autosomal dominant polycystic kidney disease(ADPKD) with spontaneous rupture and hemorrhage, combined with ipsilateral ureteral calculi(PKIUC). Methods We reported the clinical data of onecase of PKIUC, and reviewed related literature. Results The patient was diagnosed as PKIUC according to the preoperative related check, physicalexamination and medical history. Retroperitoneal laparoscopic exploration of left kidney was performed. The large retroperitoneal hematoma was ajelly-like deep dark blood clot with a thick wall, extensively adhesive to the surrounding tissue. Open surgery via left flank was finally applied to re-move the hematoma, and to perform ureteral lithotomy simultaneously. Conclusion ADPKD has a long duration and poor prognosis. Large cysts areclosely associated with cystic hemorrhage and infection, resulting in extensive adhesions of perinephric area. Decompression of cysts can reducesymptoms and delay disease progression. Mild cystic hemorrhage can be treated conservatively, while simultaneous open surgery is feasible for ADPKD patients bearing huge cystic hematoma combined with ureteral calculi.
Objective To explore the clinical characteristics, treatment and prognosis of autosomal dominant polycystic kidney disease(ADPKD) with spontaneous rupture and hemorrhage, combined with ipsilateral ureteral calculi(PKIUC). Methods We reported the clinical data of onecase of PKIUC, and reviewed related literature. Results The patient was diagnosed as PKIUC according to the preoperative related check, physicalexamination and medical history. Retroperitoneal laparoscopic exploration of left kidney was performed. The large retroperitoneal hematoma was ajelly-like deep dark blood clot with a thick wall, extensively adhesive to the surrounding tissue. Open surgery via left flank was finally applied to re-move the hematoma, and to perform ureteral lithotomy simultaneously. Conclusion ADPKD has a long duration and poor prognosis. Large cysts areclosely associated with cystic hemorrhage and infection, resulting in extensive adhesions of perinephric area. Decompression of cysts can reducesymptoms and delay disease progression. Mild cystic hemorrhage can be treated conservatively, while simultaneous open surgery is feasible for ADPKD patients bearing huge cystic hematoma combined with ureteral calculi.
引文
[1]薛澄,周晨辰,梅长林.常染色体显性多囊肾病的预后评估及治疗[J].协和医学杂志,2018,9(1):75-80.
[2] Lanktree MB, Chapman AB. New treatment paradigmsfor ADPKD:moving towards precision medicine[J].Nat Rev Nephrol, 2017,13(12):750-768.
[3]丁国栋.微创经皮肾碎石术治疗多囊肾合并上尿路结石[J].现代诊断与治疗,2017,28(3):417-419.
[4]陈熳,谢院生.常染色体显性遗传性多囊肾病发病机制及治疗靶点的研究进展[J].中华肾病研究电子杂志,2017,6(1):34-38.
[5]吴芸冰.常染色体显性多囊肾病研究现状及进展[J].医学研究生学报,2016,29(6):668-672.
[6]李海波,李超志,沈群山,等.腹腔镜下行去顶开窗术治疗多囊肾合并多囊肝临床价值并文献复习[J].实用肝脏病杂志,2014(6):628-631.
[7]闵杰,吴明灿,姚远,等.多囊肾合并颅内动脉瘤性蛛网膜下腔出血2例临床分析并文献复习[J].临床神经外科杂志,2017,14(2):142-144.
[8]闵杰,王仙,张双,等.多囊肾合并动脉瘤性蛛网膜下腔出血1例[J].中国临床神经外科杂志,2017,22(8):548.
[9]吴晓媛,白雪源.常染色体显性遗传性多囊肾病的诊疗进展[J].解放军医学杂志,2017,42(11):1020-1024.
[10]张慧峰,于为民,郭永艳,等.PKD1基因新突变导致常染色体显性多囊肾病[J].中国中西医结合肾病杂志,2017,18(6):522-523.
[11]连晓英,白雪源,张英杰.多囊肾细胞增殖和凋亡机制及治疗研究进展[J].解放军医学杂志,2016,41(11):949-954.
[12]张瑜,张慧.常染色体显性遗传多囊肾研究进展[J].中国实用医药,2016,11(26):287-288.
[13]李聪,吴寅,李鹏,等.常染色体显性多囊肾病治疗药物的研究进展[J].现代药物与临床,2015(9):1167-1171.
[14]李锦楠,蒋齐,彭迪.常染色体显性遗传多囊肾的治疗选择[J].国际泌尿系统杂志,2017,37(2):299-302.
[15] Agarwal M, Sokhal AK, Kumar M, et al. Haematuria inADPKD:not always benign. Be aware[J]. BMJ CaseRep, 2017,22(10):638-640.
[16]潘卉萱,任伟,兰雷,等.常染色体显性遗传性多囊肾病合并感染患者临床特点及病原菌分析[J].安徽医学,2016,37(9):1093-1095, 1096.
[17]朱平宇,程树林,邓显忠,等.多囊肾合并上尿路结石的微创治疗[J].川北医学院学报,2016,31(1):70-72.
[18]郭军,丁瑜,李晓燕.低能量、低剂量体外震波碎石术治疗多囊肾合并肾结石[J].宁夏医科大学学报,2014,36(10):1161-1162.
[19]蒋华国.微创经皮肾镜取石术治疗上尿路结石患者的临床分析[J].当代医学,2018,24(12):148-149.
[20]杨炜青,李逊,何永忠,等.输尿管软镜与微创经皮肾镜治疗多囊肾合并肾结石的疗效比较[J].中华腔镜泌尿外科杂志,2016,10(3):5-8.
[21]曾智辉,陈国强,马庆红,等.逆行经尿道输尿管软镜下囊肿切开内引流术和钬激光碎石取石术治疗多囊肾合并结石13例[J].福建医药杂志,2015,37(2):54-56.
[22]龚臣,邱彩菊.比较经输尿管镜气压弹道碎石术与钬激光碎石术治疗输尿管结石的疗效[J].当代医学,2018,24(17):90-92.
[23]王妍妮,解建国.后腹腔镜肾囊肿去顶减压术对多囊肾患者肾功能指标及主动脉根部内径的影响[J].河北医科大学学报,2017,38(8):950-953.
[24]钟义洋,潘斌.后腹腔镜肾囊肿去顶减压术治疗成人型多囊肾疗效观察[J].山东医药,2013,53(12):70-71.
[25] Messa P, Alfieri CM, Montanari E, et al. ADPKD:clinical issues before and after renal transplanta-tion[J]. J Nephrol, 2016,29(6):755-763.
[26] Mcewan P, Bennett WH, Ong A, et al. A model to pre-dict disease progression in patients with autosomaldominant polycystic kidney disease(ADPKD):the ADP-KD Outcomes Model[J]. BMC Nephrol, 2018,19(1):37.
[2] Lanktree MB, Chapman AB. New treatment paradigmsfor ADPKD:moving towards precision medicine[J].Nat Rev Nephrol, 2017,13(12):750-768.
[3]丁国栋.微创经皮肾碎石术治疗多囊肾合并上尿路结石[J].现代诊断与治疗,2017,28(3):417-419.
[4]陈熳,谢院生.常染色体显性遗传性多囊肾病发病机制及治疗靶点的研究进展[J].中华肾病研究电子杂志,2017,6(1):34-38.
[5]吴芸冰.常染色体显性多囊肾病研究现状及进展[J].医学研究生学报,2016,29(6):668-672.
[6]李海波,李超志,沈群山,等.腹腔镜下行去顶开窗术治疗多囊肾合并多囊肝临床价值并文献复习[J].实用肝脏病杂志,2014(6):628-631.
[7]闵杰,吴明灿,姚远,等.多囊肾合并颅内动脉瘤性蛛网膜下腔出血2例临床分析并文献复习[J].临床神经外科杂志,2017,14(2):142-144.
[8]闵杰,王仙,张双,等.多囊肾合并动脉瘤性蛛网膜下腔出血1例[J].中国临床神经外科杂志,2017,22(8):548.
[9]吴晓媛,白雪源.常染色体显性遗传性多囊肾病的诊疗进展[J].解放军医学杂志,2017,42(11):1020-1024.
[10]张慧峰,于为民,郭永艳,等.PKD1基因新突变导致常染色体显性多囊肾病[J].中国中西医结合肾病杂志,2017,18(6):522-523.
[11]连晓英,白雪源,张英杰.多囊肾细胞增殖和凋亡机制及治疗研究进展[J].解放军医学杂志,2016,41(11):949-954.
[12]张瑜,张慧.常染色体显性遗传多囊肾研究进展[J].中国实用医药,2016,11(26):287-288.
[13]李聪,吴寅,李鹏,等.常染色体显性多囊肾病治疗药物的研究进展[J].现代药物与临床,2015(9):1167-1171.
[14]李锦楠,蒋齐,彭迪.常染色体显性遗传多囊肾的治疗选择[J].国际泌尿系统杂志,2017,37(2):299-302.
[15] Agarwal M, Sokhal AK, Kumar M, et al. Haematuria inADPKD:not always benign. Be aware[J]. BMJ CaseRep, 2017,22(10):638-640.
[16]潘卉萱,任伟,兰雷,等.常染色体显性遗传性多囊肾病合并感染患者临床特点及病原菌分析[J].安徽医学,2016,37(9):1093-1095, 1096.
[17]朱平宇,程树林,邓显忠,等.多囊肾合并上尿路结石的微创治疗[J].川北医学院学报,2016,31(1):70-72.
[18]郭军,丁瑜,李晓燕.低能量、低剂量体外震波碎石术治疗多囊肾合并肾结石[J].宁夏医科大学学报,2014,36(10):1161-1162.
[19]蒋华国.微创经皮肾镜取石术治疗上尿路结石患者的临床分析[J].当代医学,2018,24(12):148-149.
[20]杨炜青,李逊,何永忠,等.输尿管软镜与微创经皮肾镜治疗多囊肾合并肾结石的疗效比较[J].中华腔镜泌尿外科杂志,2016,10(3):5-8.
[21]曾智辉,陈国强,马庆红,等.逆行经尿道输尿管软镜下囊肿切开内引流术和钬激光碎石取石术治疗多囊肾合并结石13例[J].福建医药杂志,2015,37(2):54-56.
[22]龚臣,邱彩菊.比较经输尿管镜气压弹道碎石术与钬激光碎石术治疗输尿管结石的疗效[J].当代医学,2018,24(17):90-92.
[23]王妍妮,解建国.后腹腔镜肾囊肿去顶减压术对多囊肾患者肾功能指标及主动脉根部内径的影响[J].河北医科大学学报,2017,38(8):950-953.
[24]钟义洋,潘斌.后腹腔镜肾囊肿去顶减压术治疗成人型多囊肾疗效观察[J].山东医药,2013,53(12):70-71.
[25] Messa P, Alfieri CM, Montanari E, et al. ADPKD:clinical issues before and after renal transplanta-tion[J]. J Nephrol, 2016,29(6):755-763.
[26] Mcewan P, Bennett WH, Ong A, et al. A model to pre-dict disease progression in patients with autosomaldominant polycystic kidney disease(ADPKD):the ADP-KD Outcomes Model[J]. BMC Nephrol, 2018,19(1):37.