目的 回顾两所紧密型医疗联合体医院腹膜后纤维化的患者人口特征、临床特征、放射学特征、治疗及部分随访结果,为该病的诊治提供更多循证依据。方法 预先统一制定好采集电子病历信息表,通过检索两所医院的电子病历系统,收集2008-01至2019-06被诊断腹膜后纤维化的患者40例,通过统一的病例回顾表格,进行病例数据采集,包括人口学、临床特征、实验室检查数据、治疗方式、治疗结果及部分患者随访结果。采用scheel影像学评估方法,分为Ⅰ型腹主动脉和(或)髂血管受累,Ⅱ型下腔静脉受累,Ⅲ型单侧或双侧输尿管受累,Ⅳ型肾门或肾动脉或肾静脉受累。结果 40例中,年龄24～83岁,平均(59.13±14.7)岁,其中男31例,女9例,男女比例3.5∶1,男性29例有不同程度吸烟史,女性均不吸烟。首发症状腰背痛、腹痛及腰背痛腹痛同时存在占65%,其次是下肢肿胀发病,无症状体检发现占5%。部分患者炎性反应指标增高,影像学结果显示Ⅰ+Ⅲ型比例最高,其次为Ⅰ型。10例进行了IgG4水平检测,5例提示IgG4水平增高,其中1例IgG4增高达正常水平的10倍以上。IgG4增高的4例患者都有高吸烟指数。治疗方式中手术联合药物比例最高,药物治疗中,激素为基石治疗。结论 老年男性患者居多,腹部CT及MRI为最普通和实用的影像学检查工具。PET-CT有助于疾病诊断,病理诊断进一步明确疾病病因,激素免疫抑制药为主要的治疗策略,配合泌尿外科D-J管治疗是改善急性症状的治疗策略。
Abstract
Objective To provide more evidence－based medical evidence for the diagnosis and treatment of retroperitoneal fibrosis.Methods The clinical data about forty patients with retroperitoneal fibrosis diagnosed and treated in two clinical centers between 2008 and 2019 was retrospectively analyzed. Such information as demographic characteristics, clinical manifestations, laboratory findings, radiological findings, modalities of treatments with RPF, outcomes of treatment and prognosis of some patients was retrieved from the electronic medical record information systems of the two hospitals. Scheel’s method was used for radiographic classification.Results These patients ranged from 24 to 83 in age, with an average age of 59.13±14.7. Thirty-one of them were males, and the ratio of males to females was 3.5∶1;Twenty-nine of the male patients smoked to different extents but none of the female patients was a smoker. 65% of the patients had such initial symptoms as abdominal pain or back pain or both, followed by leg edema. 5% of the patients without symptoms were spotted by medical examination. Some of the patients had elevated inflammation indexes. In terms of radiographic classification, most of the patients were of Class Ⅰ+Ⅲ, followed by Class I. IgG4 was tested in ten patients and was found to increase in five of these patients, and it was ten times higher than the normal value in one of the patients. The four male patients with higher IgG4 were heavy smokers.Conclusions The cross-sectional studies in the two centers show that most of the patients with retroperitoneal fibrosis are males and advanced in age. CT and MRI scans are the most common and useful tools in the diagnosis of RPF. PET-CT scans are very helpful in diagnosis of retroperitoneal fibrosis. Pathological diagnosis can help clarify the cause of the disease. Management of RPF includes medical therapy and ureteral stenting in the event of severe hydronephrosis. Glucocorticoids are the mainstay RPF treatment.
关键词
腹膜后纤维化 /
联合治疗 /
临床中心
Key words
retroperitoneal fibrosis /
medication combination /
clinical center
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