摘要
目的 提高肾结肠瘘的诊治水平。 方法 回顾性分析 6例肾结肠瘘患者的临床资料。男 4例 ,女 2例。平均年龄 37岁。右肾 4例 ,左肾 2例。原发病为肾结石合并感染者 3例 ,肾结石并发肾盂癌 1例 ,肾结核 1例 ,肾周围脓肿 1例。 6例临床上均无典型症状 ,均为逆行肾盂造影或肾穿刺造影时发现。 结果 6例均行手术治疗 ,其中行患肾切除、结肠切除对端吻合术 1例 ,行患肾切除、结肠瘘口切除修补术 2例 ,行肾盂或输尿管上段切开取石、瘘管切除、肾及结肠修补术 2例 ,肾结石并发肾盂癌 1例因患肾及结肠与周围组织粘连严重 ,无法手术切除 ,仅行活检。 6例中除肾结石并发肾盂癌 1例术后 6个月死于肺转移 ,余 5例治愈 ,术后无并发症发生 ,随访 8个月～ 9年 ,平均4 6个月 ,恢复良好。 结论 肾结石合并感染是引起肾结肠瘘的主要病因 ,逆行肾盂造影或肾穿刺造影是确诊此病的主要方法。此病一经确诊 ,应尽早手术治疗。
Objective To improve the diagnosis and tr ea tment level of reno-colic fistula. Methods The clinical data of 6 patients (4 males and 2 females,average age of 37 years) with reno-c olic fistula were analyzed retrospectively.Among them,4 cases had the fistula on the right side and 2,on the left.On etiology,3 cases had nephrolithiasis compli cated with infection;1,nephrolithiasis accompanied by carcinoma of renal pelvis; 1, tuberculosis of kidney; 1,perinephric abscess.There were no typical clinical symptoms in the 6 patients and they underwent retrograde pyelography or antegrad e pyelography for confirmation of diagnosis. Results Sur gical management was carried out in the 6 patients.Among them,1 case underwent n ephrectomy,colectomy and colocolostomy;2,nephrectomy,fistulectomy and repair of the colon;2,pyelolithotomy or ureterolithotomy,fistulectomy and repair of the ki dney and colon;1 case of nephrolithiasis with carcinoma of renal pelvis underwen t exploratory laparotomy and tumor biopsy with no surgery due to severe adhesion of the kidney and colon with the peripheral tissues.Five patients were followed up for 8 months to 9 years (mean,46 months) postoperatively;no surgical complic ation occurred and they had a satisfactory recovery.Only 1 case died of metastas is of tumor 6 months postoperatively. Conclusions Nephro lithiasis complicated with infection is a major cause of reno-colic fistula.Ret rograde pyelography or antegrade pyelography is the most reliable method in the diagnosis of reno-colic fistula.As soon as the diagnosis is made, surgical trea tment should be performed.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第2期94-96,共3页
Chinese Journal of Urology
