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摘要: 输尿管十二指肠瘘临床极其罕见，国内外仅报道24例，本文报道1例45岁男性患者，以右腰部间歇性胀痛伴反复发热3个月余入院。术前诊断为右肾无功能、右肾积水并感染、右输尿管扩张。行右肾切除术后第3天右侧腹膜后引流管引出墨绿色液体，通过口服造影剂后行CT平扫及重建确诊为输尿管十二指肠瘘。经保守治疗3周瘘管仍未闭合，进行瘘管切除与十二指肠瘘口修复术。追问患者病史，了解到患者幼时有多次小便排蛔虫病史，考虑蛔虫为可能病因。通过回顾性分析其临床资料和复习文献，探讨输尿管十二指肠瘘病因、临床表现、诊断与治疗。Abstract: The ureteroduodenal fistula is extremely rare, and just 24 cases were reported at home and abroad. In our study, a 45-year-old man was admitted to the hospital for suffering from intermittent right loin pain with fever repeatedly for more than 3 months. The preoperative diagnosis was nonfunctioning right kidney, right hydronephrosis with infection and dilatation of the right ureter. On the third day after the operation of right nephrectomy, dark green fluid was collected from right retroperitoneal drainage tube. CT scan and reconstruction were performed after administration of oral contrast agents, by which the patient was diagnosed as ureteroduodenal fistula. After 3 weeks of conservative treatment, the fistula had still not closed. Further, the treatment was fistulectomy and duodenal repair. When a detailed inquiry was made about the patient's medical history, it was learned that the patient had discharged ascaris from the urethra repeatedly in childhood. Therefore, ascaris is a possible etiologic factor. This paper investigates the etiology, clinical manifestation, diagnosis, treatment of ureteroduodenal fistula by retrospective analysis of this case and review of the literature.
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Key words:
- ureteroduodenal fistula /
- ascaris /
- nephrectomy /
- fistulectomy /
- case report
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表 1 输尿管十二指肠瘘报道汇总
病例 性别 年龄/岁 症状 瘘管位置 治疗方式 可能病因 作者 年份 1 男 29 右腰痛，膀胱刺激征，反复发热 右输尿管上段-十二指肠 肾切除，瘘管切除 肾感染 Davis EG 1918 2 男 20 尿频尿急尿痛 右输尿管上段-十二指肠降段 瘘管切除术 蛔虫 宁天枢 1959 3 男 45 间歇性右腹疼痛 右输尿管上段(UPJ下1 cm)-十二指肠降段 拒绝手术 十二指肠溃疡，炎症 Hoare EM 1972 4 男 47 右季肋区疼痛进而转右腰痛，气尿 右输尿管上段(UPJ下1 cm)-十二指肠降段 拒绝手术 十二指肠溃疡炎症 Hoare EM 1973 5 男 24 右腰痛伴发热，尿蛔虫，反复尿路感染 右输尿管中段-十二指肠降部水平部交界处 瘘管切除术 十二指肠憩室，蛔虫 Shiozaki H 1975 6 男 55 尿路感染，气尿 右输尿管-十二指肠降段 输尿管游离造瘘，瘘自行闭合 不明 Nemeth CJ 1975 7 男 5 反复尿痛尿频发热，气尿，尿蛔虫 右输尿管上段-十二指肠降部 瘘管切除修补术 蛔虫 - 1977 8 男 12 反复尿蛔虫，发热 右输尿管上段(UPJ下5 cm)-十二指肠降段 瘘管切除修补术 蛔虫 朱鹏英 1980 9 男 25 反复尿路感染，气尿 右输尿管上段-十二指肠水平部 肾输尿管切除，瘘管切除 创伤 McElwee TB 1983 10 男 73 右侧腰痛、发热，恶心呕吐 右输尿管上段UPJ下1 cm，-十二指肠 肾输尿管切除+瘘管切除术。 原发 Sumiya H 1985 11 男 34 反复气尿及尿蛔虫，尿路感染 右输尿管上段(UPJ下7 cm)-十二指肠降段 右肾上段输尿管切除术，瘘管切除术 蛔虫，十二指肠憩室 孙玉成 1986 12 男 48 手术误伤输尿管，吻合术后肾瘘管造影发现瘘 右输尿管-十二指肠瘘 瘘管切除 医源性 Infantino A 1987 13 男 41 右腰痛，发热 右输尿管上段-十二指肠水平部 瘘管切除，异物取出 异物塑料叉 Roberts BJ 1996 14 男 20 枪伤术后腹腔引流胆汁样液体 输尿管上段-十二指肠降段 肾造瘘引流，鼻肠管营养支持 外伤 Cooper CS 1996 15 男 28 反复尿路感染 右输尿管中段-十二指肠水平部 瘘管切除，十二指肠憩室切除 十二指肠憩室 Sinha T 1999 16 男 20 右腰痛 右输尿管上段十二指肠降段 瘘管切除术 十二指肠溃疡 Wu ST 2000 17 女 68 输尿管狭窄定期输尿管镜及IVU随访发现瘘 左输尿管上段(UPJ下2 cm)-十二指肠升段 肾输尿管切除，瘘管切除 肾周感染或医源性 Shiff BM 2000 18 女 35 右腰痛伴发热，尿食物碎屑 右输尿管上段-十二指肠降部与水平部交界处 瘘管切除术 自发性 Srivastava DN 2002 19 女 63 右腰痛，肉眼血尿 右输尿管上段(UPJ下2 cm)-十二指肠降段 右侧肾及上段输尿管切除术，上段空肠Roux-Y吻合术 肾脏黄色肉芽肿(肾实质炎症) 王道虎 2012 20 男 29 尿痛 右输尿管上段-十二指肠水平部 移除支架，切除瘘管 医源性异物，双J管 Patel B 2015 21 男 50 右腰痛腹痛 右输尿管上-十二指肠球 经皮肾造瘘，建议肾，瘘管切除 十二指肠溃疡 Lee I 2015 22 男 68 发热 右UPJ-十二指肠降部水平部交界 瘘管切除，双J管内引流 十二指肠憩室，结石 牛家增 2019 23 男 23 反复尿蛔虫及食物碎屑 右输尿管上段-十二指肠降段 瘘管切除修补术 蛔虫 Mukhopadhyay NN 2022 24 女 66 2次输尿管镜碎石后出现败血症 右输尿管近端-十二指肠降部 肾切除，瘘管切除 医源性，肾炎，结石 Makary J 2022 25 男 45 右腰部胀痛伴发热 右输尿管上段-十二指肠水平部 肾切除，瘘管切除 蛔虫 谭伍兵 2022 
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