Idiopatska retroperitonealna fibroza: rezultati lečenja 15 bolesnika

  • Jovan Hadži-Djokić Serbian Academy of Sciences and Arts, Belgrade, Serbia
  • Tomislav Pejčić Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia
  • Dragoslav Bašić Urological Clinic, Clinical Center Niš, Niš, Serbia
  • Ivana Vukomanović Department of Urology, Medical Center Bežanijska Kosa, Belgrade, Serbia
  • Zoran Džamić Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Miodrag Aćimović Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milan Radovanović Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia
DOI: https://doi.org/10.2298/5987
Ključne reči: retroperitoneal fibrosis||, ||fibroza, retroperitonealna, diagnosis, differential||, ||dijagnoza, diferencijalna, urologic surgical procedures||, ||hirurgija, urološka, procedure,

Sažetak


Uvod/Cilj: Retroperitonealna fibroza (RPF) predstavlja hronični patološki proces koji karakteriše fibroza koja obuhvata i pritiska ureter i velike krvne sudove u retroperitonealnom prostoru. Specifičan oblik RPF je idiopatska RPF, retka vaskularna kolagena bolesti nejasne etiologije. U ovom radu predstavljena je grupa od 15 bolesnika koji su operisani zbog idiopatske RPF. Metode. Od 1989. do 2012. ukupno 11 muškaraca i četiri žene operisani su zbog primarne RPF. Ureteri su bili zahvaćeni jednostrano kod sedam bolesnika ili bilateralno kod osam bolesnika. Glavni simptomi bili su lumbalni bol zbog hidronefroze, uremija i infekcije urinarnog trakta. Dijagnoza je postavljena na osnovu intravenske urografije (IVU), retrogradne ureteropijelografije i kompjuterizovane tomografije (KT). Rezultati. Primenjene su sledeće hirurške procedure: intraperiteonalno postavljanje uretera kod osam bolesnika i obmotavanje uretera omentalnim flapom kod šest bolesnika. Kod jednog bolesnika učinjena je bilateralna resekcija stenotičnog segmenta i ureterografija, a potom i obmotavanje uretera omentalnim flapom. Patološki pregled potvrdio je postojanje primarne RPF kod svih bolesnika. Prosečno trajanje operacije bilo je 3,5 sata (od 2,5 do 4,5 sata). Prosečni boravak u bolnici bio je 21 dan (od 16 do 26 dana). Prosečno praćenje iznosilo je 32 meseca (od 6 do 46 meseci). Tokom praćenja, kod 12 bolesnika primenom IVU konstantovano je poboljšanje. Zaključak. Rano prepoznavanje znakova i simptoma RPF od najveće je važnosti za ishod lečenja. Hirurški zahvati, uključujući obmotavanje uretera omentalnim flapom ili intraperitonealno postavljanje uretera, obično predstavljaju definitivno lečenje.

Biografije autora

Jovan Hadži-Djokić, Serbian Academy of Sciences and Arts, Belgrade, Serbia
Head of Urgent Urology Department, Clinical center of Serbia
Milan Radovanović, Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia
Resident of Urology

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Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 10 (2015)
Rubrika
Kratko saopštenje