目的:腹膜后纤维化是一种罕见的疾病,其特征是腹膜后间隙的慢性炎症和纤维化,可能包裹输尿管并引起梗阻。在这里,我们介绍了2022年4月至8月期间诊断和治疗的三名患者的病例。
方法:这里我们介绍3例腹膜后纤维化。影像学显示肾积水和/或输尿管扩张,而实验室发现,如红细胞沉降率,C反应蛋白,免疫球蛋白G4异常。血清肌酐和血尿素氮水平提示肾损伤。此外,两名患者的其他医院诊断不清.稍后,所有患者均在我院接受了输尿管支架置入术和腹腔镜输尿管溶解术,同时通过活检进行诊断.具有高免疫球蛋白G4水平的两名患者表现出极其严重的纤维化。放电后,每个人都接受了维持泼尼松以防止复发以及甲氨蝶呤,随后每3个月随访一次。幸运的是,血清肌酐,血尿素氮,静脉尿路造影结果保持正常,平均随访8.5个月。
结论:在这里,我们发现了腹膜后纤维化的诊断和治疗的有趣发现,包括药物加手术治疗的稳定效果,输尿管梗阻的病因不清楚,免疫球蛋白G4水平与纤维化硬度的关系。然而,这些新发现背后的机制需要进一步研究。
OBJECTIVE: Retroperitoneal fibrosis is a rare disease characterized by chronic inflammation and fibrosis in the retroperitoneal space that may wrap around the ureter and cause an obstruction. Here we present the cases of three patients diagnosed and treated between April and August 2022.
METHODS: Here we present three cases of retroperitoneal fibrosis. Imaging revealed hydronephrosis and/or ureteral dilation, whereas laboratory findings such as erythrocyte sedimentation rate, C-reactive protein, and immunoglobulin G4 were abnormal. Serum creatinine and blood urea nitrogen levels suggested renal injury. Additionally, two patients had unclear diagnoses from other hospitals. Later, all patients underwent ureteral stenting and laparoscopic ureterolysis at our hospital and simultaneous diagnosis by biopsy. The two patients with high immunoglobulin G4 levels exhibited extremely severe fibrosis. After discharge, each received maintenance prednisone to prevent recurrence as well as methotrexate, followed by follow-up every 3 months. Fortunately, serum creatinine, blood urea nitrogen, and intravenous urography findings remained normal with an average follow-up of 8.5 months.
CONCLUSIONS: Here we discovered interesting findings in the diagnosis and treatment of retroperitoneal fibrosis, including the stable effect of medical plus surgical treatment, an unclear ureteral obstruction etiology, and the relationship between immunoglobulin G4 level and fibrosis hardness. However, the mechanisms behind these new findings require further study.