後腹腔纖維化:診斷及治療上的挑戰-台北榮總的經驗分享
劉家翔1、魏子鈞1,2、林登龍1,2、陳光國1,2
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Retroperitoneal fibrosis: challenge in diagnosis and treatment - a single institute experience
Chia-Hsiang Liu, Tzu-Chun Wei, Alex T. L. Lin, Kuang-Kuo Chen
Department of Urology1, Taipei Veterans General Hospital, Taiwan
Department of Urology, School of Medicine, and Shu-Tien Urological Institute2, National Yang Ming University, Taipei, Taiwan
Purpose: The diagnosis and treatment of retroperitoneal fibrosis is still difficult in clinical practice. Some articles were tried to analyze the characteristics of these patients and compare the treatment efficacy. However, there is still much to be mentioned. This study was aimed to describe the clinical manifestations, laboratory results, diagnostic tool, and treatments in patients with retroperitoneal fibrosis at Taipei Veterans General Hospital.
Materials and Methods: From January 2005 to August 2015, we retrospectively reviewed the patients who were diagnosed with retroperitoneal fibrosis via ICD-9 code(594.3). The data we collected including age, sex, height, weight, BMI, BSA, initial renal function, serum IgG4 level, hydronephrosis condition, diagnostic tool, further treatment and post-treatment renal function.
Results: Total 30 patients were included, 23 were male (77%) and 7 were female (23%). Mean age was 65.9 ± 16.37. Biopsy specimens were available in 13 cases (43%). The mean serum creatinine at diagnosis was 2.28 ± 1.85 mg/dL). Half of the patients had serum IgG4 test, and the mean was 249.3 ± 205.1 mg/dL. Twenty-one patients (70%) were treated with ureteral procedures only (17 double J stenting, 2 reconstruction and 2 ureterolysis) , 2 patients (7%) with medications only, and 3 patients (10%) with a combination of medical and double J stenting. Corticosteroids were initiated in 5 patients (17%), and immunomodulator was used in 2 patients (7%). Follow-up data wre available in 27 patients (90%)..Creatinine levels were normal (<1.5 mg/dL) at last visit in 16 patients (59%) of the 27 patients.More than half patient(53%)with improved renal function(creatinine) was under ureteral procedure.(double J stenting, reconstruction and ureterolysis)
Conclusion: Retroperitoneal fibrosis in Taipei Veterans General Hospital was diagnosed mostly via laboratory results (IgG4 in 15 patients and increased level in 10 patient)or biopsy (43% of 30 patients with fibrosis in pathology report).Ureteral procedure(double J stenting, reconstruction and ureterolysis) was preferred as compared with medication only