Schwarz A, Lenz T, Klaen R, Offermann G, Fiedler U, Nussberger J
Medizinische and Urologische Klinik, Klinikum Steglitz, Berlin, Germany.
J Urol. 1993 Sep;150(3):953-7. doi: 10.1016/s0022-5347(17)35660-4.
A total of 42 cases of large symptomatic parapelvic or pararenal lymphatic cysts has been reported since 1890, of which 54% were associated with hypertension and 14% were bilateral. We report on a patient in whom during a 3-month period abdominal pain and distention developed successively on both sides associated with hypertension. Initially, ultrasound and computerized tomography revealed a large multicystic pararenal lymphatic mass on the right side and small parapelvic hilus lesions on the left side. Two months after resection and marsupialization of the large cyst on the right side the small hilus lesions on the left side developed into large pararenal cysts requiring the same therapeutic measures. Hypertension was reversible after surgery in both instances; at the second operation high preoperative and lower postoperative renin activity, active renin, total renin, aldosterone and atrial natriuretic factor in plasma were noted. Immunoreactive active and total renin levels in the lymph fluid were elevated, a finding that may be explained by the renal origin of the lymph. Marsupialization is a kidney preserving measure that reverses all symptoms of large pararenal cysts, including Page kidney hypertension.
自1890年以来，共报告了42例有症状的巨大盆腔旁或肾旁淋巴囊肿病例，其中54%与高血压相关，14%为双侧性。我们报告了1例患者，在3个月内双侧先后出现腹痛和腹胀，并伴有高血压。最初，超声和计算机断层扫描显示右侧有一个巨大的多囊性肾旁淋巴肿块，左侧有小的盆腔旁肾门病变。右侧大囊肿切除并开窗引流2个月后，左侧小的肾门病变发展为巨大的肾旁囊肿，需要采取相同的治疗措施。在这两个病例中，高血压在手术后均可逆转；在第二次手术时，术前血浆肾素活性、活性肾素、总肾素、醛固酮和心房利钠因子较高，术后较低。淋巴液中免疫反应性活性肾素和总肾素水平升高，这一发现可能与淋巴的肾脏起源有关。开窗引流是一种保留肾脏的措施，可逆转巨大肾旁囊肿的所有症状，包括佩奇肾性高血压。
