Lub raum ua haujlwm thiab tso zis niaj hnub yog qhov qub, tab sis raum B-ultrasound tau pom qhov txawv txav, yuav kho li cas?
Mar 28, 2023
Hnub no, tau pom ib tug tub muaj hnub nyoog 28- xyoo nyob hauv tsev kho mob sab nraud. Nws tau hais tias thaum lub sijhawm kuaj lub cev, nws lub raum kev ua haujlwm thiab cov zis niaj hnub yog qhov qub, tab sis tus kws kho mob ultrasound tau hais tias nws lub raum txawv ntawm lwm tus. Nws hais kom nws mus rau ib lub tsev kho mob ib txwm zoo li peb mus kuaj xyuas ib zaug.
Nyem rau cistanche tubulosa capsules rau kab mob raum
Nrog kev ua xyem xyav, cia peb nkag siab txog tus kab mob ua ntej, thiab tom qab ntawd muab nws nrog qhov tseeb los ua cov lus qhia rau kev kho mob ntawm cov neeg mob.
etiology thiab pathogenesis
Medullary sponge raum tsis yog ib hom kab mob raum, nws qhov tshwm sim ntawm cov pej xeem yog 1/20000-1/5000[1], thiab nws yog ib qho kab mob hauv lub raum tsis zoo. Lub hnub nyoog pib yog 30 mus rau 50 xyoo, ntau tus poj niam tshaj li txiv neej, nrog tsev neeg aggregation yam ntxwv, manifested li autosomal dominant qub txeeg qub teg.
Cov kab mob pathological tshwm sim yog ib leeg lossis ntau yam papillae hauv ib lossis ob lub raum. Intrarenal medullary sau ducts thiab papillary ducts nyob rau hauv lub pyramidal ib feem yog fusiform los yog me me cystic expansions, uas muaj cov high-density tshuaj, thiab muaj ntau ntau yam sib txawv. Cov pob zeb me me uas muaj calcium tsis sib xws, thiab ob peb lub raum parenchymal calcifications.
Medullary sponge raum kab mob tuaj yeem ua asymptomatic thaum nyob hauv cheeb tsam thiab tsis yooj yim, yog li kev kuaj mob ntxov tseem ceeb heev. Raws li tus kab mob loj tuaj, pob zeb raum thiab nephrocalcinosis feem ntau nyuaj. Lwm qhov kev kho mob tshwm sim muaj xws li hematuria, kab mob hauv lub cev, hyperparathyroidism, thiab txawm tias lub raum tsis txaus, thaum kub siab thiab proteinuria tsis tshua muaj. Lub raum medullary sponge feem ntau nrog rau lwm yam kab mob hauv lub cev, xws li Sjogren's syndrome, hemihypertrophy, horseshoe raum, Marfan syndrome, thiab congenital intrahepatic bile duct dilatation, thiab lwm yam.[1,2].
Lub etiology ntawm lub raum medullary daim txhuam cev tseem tsis tau paub meej. Nyob rau hauv xyoo tas los no, kev sib tawg tau ua nyob rau hauv txoj kev tshawb no ntawm nws cov kab mob pathogenesis raws li cov noob caj noob ces. Nws ntseeg tau hais tias polymorphic neurotrophic yam thiab receptor tyrosine kinases muab tau los ntawm glial cell kab nyob rau hauv embryonic txoj kev loj hlob Ib los yog ntau tshaj kev hloov los yog polymorphisms ntawm cov noob ua rau muaj kev cuam tshuam ntawm "ureteric bud-metanephric mesenchyme" interface, ua rau kev loj hlob txawv txav ntawm lub raum ureter. sau cov ducts ua rau pathogenesis [2].
kev kuaj mob
Feem ntau siv kho mob rau kev kuaj mob ntawm lub raum medullary daim txhuam cev yog lub raum B-ultrasound thiab CT.
B ultrasound
Zoo li cov neeg mob hauv kab lus no, feem ntau ntawm lawv tau kuaj pom tias muaj lub raum B-ultrasound thaum ntxov. Tej ultrasound qhia tau hais tias cov echoes ntawm lub raum pyramids yog kho kom zoo nrog paj rwb zoo li hloov nyob rau hauv radial tis, thiab cov echo me ntsis muaj zog yog feem ntau calcifications thiab pob zeb me me, nrog rau acoustic duab ntxoov ntxoo nyob rau hauv lub rear, thiab ntau anechoic me ntsis ntawm ntau ntau thiab tsawg pab tau. yuav tsum tau qhia Cov cheeb tsam no feem ntau yog tsim los ntawm cystic dilation ntawm lub sau duct, thiab feem ntau, tsis muaj hydronephrosis ntawm lub raum pelvis thiab calyces.
Txawm li cas los xij, vim qhov me me ntawm medullary cavernous raum cysts, B-ultrasound yog qhov nyuaj kom pom tseeb, thiab muaj kev txwv rau kev kuaj mob.
CT
Cov duab CT ib txwm ntawm lub raum medullary daim txhuam cev qhia tau hais tias lub dilated sau duct nthuav tawm qis-density, striated me cystic ntxoov ntxoo. Yog hais tias nrog rau lub raum pob zeb, nws zoo nkaus li tawg, clustered, los yog kiv cua-zoo li tus duab ntxoov ntxoo siab. Enhanced CT qhia tau hais tias lub dilated collecting duct yog striated los yog me me-zoo li tus neeg sawv cev saccumulation, thiab thaum nrog rau lub raum pob zeb, nws qhia tau hais tias lub collecting duct tau sau nrog contrast agent nyob ib ncig ntawm lub pob zeb. CT tam sim no yog txoj kev nyiam rau kev kuaj mob ntawm lub raum medullary daim txhuam cev.
Raws li kev txhaj tshuaj pyelography (IVP) thiab MRI, ob qhov kev kuaj mob no tsis yog kim xwb tab sis kuj qis dua ob qhov kev ntsuam xyuas saum toj no hais txog qhov zoo ntawm kev kuaj mob ntawm lub raum medullary sponge. Cov kev tshawb fawb tau pom tias txawm tias qhov rhiab heev ntawm IVP hauv kev kuaj mob medullary sponge raum siab dua li ntawm CT, CT yog qhov zoo dua li IVP hauv kev nthuav qhia tus naj npawb, qhov chaw, thiab cov duab ntawm lub raum pob zeb me me, thiab nws yooj yim los kuaj xyuas lub raum papilla calcification. , yog li nws tau hloov los ntawm CT.
MRI tsis muaj rhiab heev rau kev kuaj mob ntawm medullary sponge ob lub raum thiab tsis muaj rhiab heev rau calcifications thiab pob zeb. MRI tuaj yeem pom tsuas yog thaum lub cystic nthuav dav ntawm cov hlab ntim hauv lub medullary medulla ntawm lub raum medullary daim txhuam cev yog pom tseeb, yog li nws tsis pom zoo.
kho
Yog tias tus neeg mob tsis muaj cov tsos mob tshwm sim lossis muaj teeb meem, tsis tas yuav muaj kev kho mob tshwj xeeb. Qhia rau tus neeg mob kom haus dej kom ntau thiab noj cov zaub mov uas tsis muaj calcium, tsawg-oxalate kom txo cov pob zeb thiab tiv thaiv cov teeb meem.
Cov neeg mob uas muaj calcium ntau metabolism tuaj yeem kho tau zoo nrog thiazide diuretics thiab potassium citrate thiab lwm yam tshuaj calcium uas txo qis kom tsis txhob muaj pob zeb.
Lub raum medullary sponge feem ntau yog nrog rau microscopic hematuria. Tag nrho hematuria tsis tshua muaj. Nws feem ntau tshwm sim los ntawm ob lub raum pob zeb, kis kab mob, thiab muaj zog ntxiv ntawm dilated raum tubules. Feem ntau, hematuria tsis xav tau kev kho mob tshwj xeeb.
Yog tias nws tshwm sim los ntawm pob zeb, kev phais tshem tawm pob zeb yuav raug txiav txim siab.
Yog tias nws tshwm sim los ntawm kev kis kab mob, kev kho tshuaj tiv thaiv kab mob yuav tsum tau muab. Kev mob nraub qaum qis yog tsawg tsawg hauv lub raum medullary sponge, thiab yog tias nws tshwm sim, nws yuav tsum tau sib txawv ntawm qhov mob qis los ntawm lwm yam kab mob[2].
Kev kho mob ntawm cov teeb meem
Cov kab mob hauv lub raum cyst
Yog tias muaj lub raum loj loj uas ua rau hematuria thiab mob nraub qaum, kev kho mob feem ntau yog ultrasound-guided percutaneous lub raum cyst puncture thiab txhaj tshuaj ntawm tus neeg saib xyuas sclerosing lossis laparoscopic lub raum cyst decompression ua ke nrog kev haus cawv sclerotherapy.
▌ Acid metabolism abnormalities
Cov neeg mob uas muaj medullary daim txhuam cev raum feem ntau muaj lub raum tubular acidosis thiab hypocitraturia.
▌ Kab mob urinary thiab pob zeb
Kev khaws cia ntev ntawm cov zis nyob rau hauv lub dilated sau duct thiab cov pob zeb tsim tuaj yeem ua rau muaj kab mob urinary rov qab, thiab kev kho mob tiv thaiv kab mob yuav tsum tau ua nyob rau lub sijhawm no. Tam sim no, nws ntseeg hais tias lub raum medullary daim txhuam cev ua rau lub raum calcium to nyob rau hauv lub distal tubules ua rau hypercalciuria thiab distal raum tubular acidosis yog lub ntsiab ua rau calculi.
Tam sim no, tsis muaj ib txoj hauv kev los tiv thaiv thiab kho cov pob zeb ntawm lub raum. Clinically, kev kho mob dav dav (xws li haus dej ntau, calcium uas tsis muaj, tsis muaj oxalate noj, alkalization ntawm cov zis, thiab tswj cov kab mob urinary), extracorporeal shock yoj lithotripsy, thiab kev kho phais siv.
Cov tsos mob ntawm tus mob hyperparathyroidism tshwm sim
Calcium metabolism tsis meej feem ntau yog tshwm sim los ntawm lub raum medullary daim txhuam cev, thiab lub sij hawm ntev hyperuria ua rau hypocalcemia, uas ua rau cov hyperparathyroidism theem nrab. Kev kho mob hauv tsev kho mob feem ntau yog kev sib xyaw ua ke ntawm kev txo cov ntshav calcium thiab tswj cov endocrine, uas tuaj yeem txiav txim siab thaum cov tsos mob hnyav Parathyroidectomy tau ua.
Tom qab nkag siab txog tus kab mob no, cia peb saib qee qhov kev kuaj mob thiab kev kho mob rau tus neeg mob no
Ua kom tiav cov kev tshuaj ntsuam xyuas hauv cov chaw kho mob sab nraud:
Cov ntshav niaj hnub: cov ntshav liab suav 4.5 × 1012 / L, hemoglobin 135g / L.
Cov zis niaj hnub: tso zis tshwj xeeb lub ntiajteb txawj nqus 1.015, protein-, cov qe ntshav dawb 126/ul, cov qe ntshav liab 3/ul.
Biochemical tsom xam: albumin 42.5g / L, creatinine 86μmol / L, urea nitrogen 4.5 mmol / L, uric acid 223μmol / L, calcium 2.07 mmol / L.
Quantitative 24-teev cov zis protein: 135.44mg/24h.
Tsib yam khoom ntawm microalbuminuria thiab parathyroid hormone rov qab yog qhov qub.
Calcium tso zis rov qab yog qhov qub.
B-ultrasound rov qab: Spongy raum hloov hauv ob lub raum.
Urinary tract CT yog raws li nram no:
CT qhia tias tus neeg mob muaj ntau lub pob zeb me me hauv ob lub raum. Tom qab sab laj tus kws kho mob urologist rau CT kev ntsuam xyuas, tsis muaj qhov qhia tau tias muaj kev cuam tshuam rau lub cev lithotripsy thiab kev phais.
Tus neeg mob tsev neeg keeb kwm tau nug txog kom meej, thiab nws tau hais tias nws txiv tau ua haujlwm ntau yam rau lub raum pob zeb, thiab nws lub raum ua haujlwm maj mam poob mus txog thaum nws tsim uremia. Nws tau raug kho nrog hemodialysis rau 3 xyoos, yog li qhov ua tau ntawm tsev neeg pawg tsis tuaj yeem txiav tawm.
Tus neeg mob tau ntxhov siab heev tom qab kawm txog nws tus mob, ntshai tias nws yuav xaus rau kev tso ntshav lim ntshav rau kev txhawb nqa lub neej zoo li nws txiv.
Kuv qhia tus neeg mob kom tsis txhob ntxhov siab heev. Tus mob tam sim no ruaj khov. Tsuas yog kev kho cov kab mob urinary, tsis muaj lwm yam kev kho mob tshwj xeeb. Qhov tseem ceeb tshaj plaws yog ua raws li niaj zaus los tiv thaiv qhov tshwm sim ntawm medullary sponge raum teeb meem. Tsis tas li ntawd, nws raug nquahu kom cov neeg mob haus dej ntau, noj zaub thiab txiv hmab txiv ntoo ntau dua, tswj kev noj zaub mov uas muaj calcium, thiab tsis tu ncua tshuaj xyuas cov zis CT thiab ua raws. Tus neeg mob tus mob tam sim no zoo.
vim li cas noj cistanche tuaj yeem kho mob raum
Cistanche ntseeg tau tias muaj kev kho mob rau cov kab mob raum vim nws cov txiaj ntsig zoo. Qee qhov laj thawj vim li cas nws ntseeg tias yuav pab kho mob raum muaj xws li:
1. Anti-inflammatory zog: Cistanche muaj lub zog tiv thaiv kab mob uas yuav pab txo qhov mob hauv lub raum, uas tuaj yeem pab tau zoo rau cov neeg mob raum.
2. Anti-oxidant zog: Cistanche muaj antioxidants uas pab neutralize teeb meem dawb radicals nyob rau hauv lub cev, uas yuav pab tau rau txoj kev loj hlob ntawm lub raum kab mob.
3. Immunomodulatory zog: Cistanche tau pom tias muaj cov nyhuv immunomodulatory, uas txhais tau tias nws yuav pab tswj lub cev tiv thaiv kab mob thiab txo qhov mob thiab kev puas tsuaj rau lub raum los ntawm kev tiv thaiv kab mob ntau dhau.
4. Kev tiv thaiv kab mob raum: Cistanche tau pom tias muaj kev tiv thaiv lub raum uas tuaj yeem pab tiv thaiv kev puas tsuaj rau lub raum thiab cov ntaub so ntswg, uas tuaj yeem ua rau mob raum qeeb.
Cov ntaub ntawv:
[1] Lin Lu, Yu Shengqiang. Kev nkag siab tshiab ntawm medullary sponge raum [J]. Suav General Medicine, 2016, 18 (18): 2213-2216
[2] Huang Fan, Li Zhipeng, Ye Chunwei. Kev nkag siab ntawm medullary daim txhuam cev raum thiab nws cov teeb meem [J]. Kev tshuaj xyuas, 2019, 25 (2): 302-306
