经皮肾穿刺双侧输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰(附1例报告并文献复习)

目的探讨采用经皮肾穿刺双侧输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰的可行性和手术效果。方法收治盆腔脂肪增多症伴急性肾衰患者1例,男性,42岁,发热1月,无尿2天,憋气、咳泡沫痰、意识恍惚2小时;膀胱造影提示典型倒梨形膀胱、后尿道延长;腹部CT示盆腔内均匀低密度脂肪堆积、双肾积水、双侧输尿管上段扩张;血肌酐1 031μmol/L、尿素氮23.3 mmol/L。诊断盆腔脂肪增多症伴双肾输尿管扩张积水、急性尿闭、急性肾衰,膀胱镜下逆行插管失败,采用经皮肾穿刺、输尿管下段扩张、输尿管支架植入术方法治疗。结合文献复习讨论经皮肾穿刺输尿管支架植入术治疗盆腔脂肪增多症伴急性肾衰的可行性和手术效果。结果术中经皮肾穿刺造影可见肾盂、肾盏及输尿管上段扩张,输尿管下段管腔狭窄;膀胱造影见典型倒梨形膀胱、后尿道延长。采用经皮肾穿刺、输尿管下段球囊扩张、输尿管支架植入术方法治疗。术后2天拔除尿管,1周后出院。2周后复查彩超示肾盂积水消失,肾功能正常。结论通常情况下盆腔脂肪增多症患者膀胱抬高,后尿道延长,膀胱镜下逆行插管失败率高,经皮肾穿刺、输尿管下段球囊扩张、输尿管支架植入术是治疗盆腔脂肪增多症伴急性肾衰的有效和微创的方法。

Bilateral ureteral stent implantation with percutaneous renal puncture in treatment of pelvic lipomatosis associated with acute renal failure.

Objective To explore the feasibility and effect of bilateral ureteral stent implantation with percutaneous renal puncture in treatment of pelvic lipomatosis associated with acute renal failure. Methods A 42 - year - old male patient with pelvic lipomatosis associated with acute renal failure was admitted with fever for one month, anuria for 2 days, and breath holding, frothy sputa, tranced for 2 hours Cystography showed a typical inverted - pear shaped bladder and extended posterior urethra. CT scanning showed low density lipid piled in pelvic cavity, bilateral hydronephrosis and bilateral upper distention of ureters. The blood level of creatinine was 1031 umol/L and blood level of urea nitrogen was 23.3 mmol/L. The diagnosis of pelvic lipomatosis with bilateral ureterectasia, bilateral hydronephrosis, acute anuria and acute renal failure. Cystoscopic retrograde intubation failed. The treatment with percutaneous renal puncture, sacculus proprius distension in inferior segment of ureter and bilateral ureteral stent implantation had been performed. In this article, based on this case and review of literatures, the feasibility and effect of operation of bilateral ureteral stent implantation by percutaneous renal puncture in treatment of pelvic lipomatosis with acute renal failure had been discussed. Results Pereutaneous renal puncture angiography showed the distention of pelvis, renal calices and inferior segment of ureter, and cystography showed a typical inverted - pear shaped bladder and extended posterior urethra. The treatment with percntaneous renal puncture, sacculus proprius distension in inferior segment of ureter and bilateral ureteral stent implantation had been performed. Urinary tube was removed at two days after operation, and this patient was discharged in one week after operation. The ultrasound imaging taken at 2 weeks after dis- charge showed disappearance of nephrydrosis and the recovery of normal renal function. Conclusion Patients with pelvic lipomatosis shows elevated bladder and extended posterior urethra. The rate of failure of cystoscopic retrograde intubation is very high. Percutaneous renal puncture, saeculus proprius distension in inferior segment of ureter and bilateral ureteral stent implantation are very effective and minimally invasive procedures for treatment of this disease.