成人肾积水病因分析:一项单中心横断面研究
Etiological analysis of hydronephrosis in adults:A single-center cross-sectional study
陈思鹭 1王海菊 2吴宇财 1李志华 2黄燕波 2何宇辉 1许洋洋 1李学松 1贯华2
作者信息
- 1. 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿男性生殖系肿瘤中心,北京 100034
- 2. 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿男性生殖系肿瘤中心,北京 100034;北京大学第一医院护理部,北京 100034
- 折叠
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.
Abstract
Objective:To investigate the etiological distribution of hydronephrosis caused by upper uri-nary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition.Me-thods:The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were pro-spectively and continuously collected.Patients with ureteral calculi or upper urinary tract tumor were ex-cluded.A total of 767 patients were involved.The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms,medical history,physical examina-tion,and a range of diagnostic imaging techniques including ultrasound,computed tomography(CT),magnetic resonance imaging(MRI),retrograde pyelography,antegrade pyelography,radionuclide reno-gram and ureteroscopy.Results:Among the 767 patients,359(46.8％)were male and 408(53.2％)were female.The median age of these patients was 37 years(range,14-84 years).Hydronephrosis was observed at left-sided in 357 cases(46.6％),right-sided in 251 cases(32.7％),and bilateral in 159 cases(20.7％).The causes of hydronephrosis were classified as follows:(1)Non-iatrogenic factors were found in 464 cases(60.5％).These included urinary malformations in 355 cases(76.5％),infec-tion in 29 cases(6.3％),pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0％),ureteral en-dometriosis in 18 cases(3.9％),retroperitoneal fibrosis in 15 cases(3.2％),trauma in 7 cases(1.5％)and other non-iatrogenic factors in 12 cases(2.6％).Some of these patients had multiple non-iatrogenic causes.Among the 355 cases with urinary system malformations,252 cases(71.0％)had ureteropelvic junction obstruction.(2)Iatrogenic ureteral injuries accounted for 210 cases(27.4％),including 112 cases(53.3％)of urological surgical injuries,51 cases(24.3％)of radiotherapy for malignant tumor re-lated injuries,34 cases(16.2％)of gynecological and obstetrical surgical injuries,and 13 cases(6.2％)of general surgical injuries.(3)The cause of hydronephrosis remained unknown in 93 cases(12.1％).Conclusion:Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of cau-ses,with urinary malformations and iatrogenic ureteral injuries being significant contributors.Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to fa-cilitate accurate diagnosis and effective treatment.
关键词
肾积水/上尿路梗阻/病因学分析Key words
Hydronephrosis/Upper urinary tract obstruction/Etiological analysis引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据