Wunderlich综合征的诊治特点

目的 探讨Wunderlich综合征的病因、诊断及治疗原则。方法 报告19例Wunderlich综合征病例。男15例，女4例。年龄11～75岁，平均47岁。依据病史、实验室及影像学检查，病因诊断为肿瘤性病变10例、非肿瘤性病变7例、病因不明2例。9例拟诊肾癌患者及1例输尿管结石伴梗阻性肾积水患者行手术治疗，余9例患者采用对症观察治疗，1例流行性出血热和1例病因不明患者有进行性出血，采用介入栓塞治疗控制出血。结果 9例肿瘤手术患者，术后恢复顺利，随访6～36个月，5例死于肿瘤复发转移，3例无瘤存活9～24个月，1例术后1年出现肝转移者已带瘤生存11个月。1例输尿管结石患者肾积水较前明显减轻，血肿消失。余9例患者均保守治疗成功。结论 肾肿瘤是Wunderlich综合征的主要病因，对非恶性肿瘤原因所致Wunderlich综合征患者应首选保守治疗。

Diagnosis and management of Wunderlich syndrome

Objective To investigate the causes,diagnosis and management of Wunderlich syndrome. Methods A total of 19 cases (15 men and 4 women) of Wunderlich syndrome were reported.Their average age was 47 years (range,11-75 years).Imaging examinations (B-ultrasound,IVU,CT,arteriography,MRI) together with laboratory testing and history supported the etiologic diagnosis of tumorous disease (n=10),non-tumorous disease (n=7) and unknown causes (n=2).Surgical management was performed in 9 cases of kidney tumor and 1 of ureter stone with obstructive hydronephrosis.Conservative treatment was adopted in the rest 9 cases.In 2 of the conservatively treated cases,the bleeding artery was embolized because of persistent bleeding. Results In the 9 tumor cases undergoing surgery,pathology confirmed renal cell carcinoma in 7,malignant fibrous histocytoma in 1 and transitional cell carcinoma of the renal pelvis in 1.These 9 cases all recovered after operation and experienced follow-up for 6 months to 3 years.Of them,5 cases died of tumor recurrence and metastasis;3 survived disease-free for 9 months to 2 years;1 had liver metastasis 1 year after operation and survived with tumor for 11 months.One case of ureter stone got significant improvement.The 9 cases undergoing conservative treatment had satisfactory results. Conclusions The main cause of Wunderlich syndrome is renal tumor.The conservative approach appears to be the most acceptable option for the patients with Wunderlich syndrome who have no malignant tumorous cause.