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目的:分析系统性红斑狼疮(SLE)性肾盂输尿管积水的临床特点,提高对SLE致膀胱输尿管病变的认识。方法:回顾性分析23例SLE性肾盂输尿管积水患者的临床资料:其中双侧肾积水18例(78.3%),单侧5例(21.7%);以恶心、呕吐、腹泻、腹痛、腹胀等消化道表现为首发症状者15例(65.2%);有严重尿频、尿急、急迫性尿失禁者13例(56.5%);腹水18例(78.3%);体重下降19例(82.6%)。23例均给予足量糖皮质激素联合环磷酰胺等治疗。结果:肾盂输尿管扩张明显改善13例(56.5%),其中完全缓解8例(34.8%);改善不明显10例(43.5%),其中3例行双肾造瘘术,1例行输尿管膀胱再植术,3例输尿管内留置D-J管。2例失访,2例死亡。获得随访者消化道症状均基本缓解。结论:SLE是肾盂输尿管积水的一种特殊病因;假性肠梗阻等消化道症状和严重的尿频、尿急是SLE性肾盂输尿管积水的重要临床特点;SLE性肾盂输尿管积水为可逆性病变,以药物治疗为主;早期诊断、联合肾上腺皮质激素和环磷酰胺等治疗多可缓解;内科治疗无效或并发肾功能不全者应积极行手术引流。
Objective: To analyze the clinical characteristics of systemic lupus erythematosus (SLE) ureteropelvic hydrocephalus and to improve the understanding of bladder ureter disease caused by SLE. Methods: The clinical data of 23 patients with hydronephrosis were retrospectively analyzed. Among them, 18 cases (78.3%) had bilateral hydronephrosis and 5 cases (21.7%) unilateral. The patients with nausea, vomiting, diarrhea, abdominal pain, abdominal distension 13 cases (56.5%) had severe urinary frequency, urgency urinary incontinence, 18 cases (78.3%) had ascites, 19 cases (82.6%) had weight loss, . 23 cases were given adequate glucocorticoid combined with cyclophosphamide and other treatment. Results: The ureteropelvic dilatation improved significantly in 13 cases (56.5%), of which 8 cases (34.8%) were completely relieved and 10 cases (43.5%) were not obviously improved. Among them, 3 cases underwent nephrostomy and 1 case underwent ureterocele 3 cases of ureteral indwelling DJ tube. Two were lost and two died. Obtained follow-up of gastrointestinal symptoms were basically relieved. Conclusions: SLE is a special etiology of hydronephrosis; Digestive tract symptoms such as intestinal obstruction and severe urinary frequency and urinary urgency are important clinical features of hydronephrosis; SLE pyeloplasty is reversible Lesions, mainly to drug treatment; early diagnosis, combined with adrenal cortex hormones and cyclophosphamide and other treatment and more can be alleviated; medical treatment inefficiency or renal dysfunction should be actively underwent surgical drainage.