The Treatment Of Idiopathic Retroperitoneal Fibrosis(IRF) With A Combination Of Prednisone And Tamoxifen After The Extraperitoneal Surgery

Objectives Steroids is the main medicine to treat idiopathic retroperitoneal fibrosis,but leads to serious complications,such as necrosis of femoral heads,with long-term application.Open surgery is the standard way to treat retroperitoneal fibrosis,we always choose the median abdominal incision to dissociate bilateral ureter,also influence the abdominal organs.The author probe into the treatment of retroperitoneal fibrosis with a combination of short-term prednisone and long-term tamoxifen after the extraperitoneal surgery.Methods Between March 2011 and March 2015,twelve patients from Shandong Provincial Hospital were referred to this study,eight patients were male and four patients were female, the ages frome 38 to 65yr.One case had intestinal surgery history,others have no operations.Lumbar painand anorexia are the main complaintment.And four cases with lower limb edema, four cases with aortic calcification,scrotal edema in one case.Mild to moderate bilateral hydronephrosis and renal insufficiency were founded,serum creatinine(Scr)200-460um/L,erythrocyte sedimentation rate(ESR)40-100.Bilateral ureteral obstruction were found through retrograde pyelography or computed tomography urography(CTU),computed tomography(CT) or magnetic resonance imaging(MRI) displayed retroperitoneal occupying. All patients were choosed to place double J stent before surgery,and 10 patients’Scr levels were reduced to normal levels after 1 week to lmonth,2 patients’ renal function improved,but still higher than normal. We used the two-incision through the rectus,to dissociate ureter from extraperitonea.The ureter was wrapped by fibrous tissue,range from the iliac artery bifurcation to pelviureteric coupling portion.The narrow section is about 6-12cm. We release the ureter fully,take a part of tissue for patholog,and suture posterior peritoneum and psoas major myofascial in the rear of the ureter to apart ureter and fibrous tissue.Prednisone 10mg once a day for three months,tamoxifen 10mg twice daily for a total of one year after surgery. After 6 weeks of surgery,we took out double J stent,in one year review renal function and hydronephrosis every three months.Results The pathology of tissues were all inflammatory cell infiltration in the fibrous tissue.Follow-up of 3 months to 36 months,An average of 18 months.Hydronephrosis disappeared in 8 cases,4 cases improved, no recurrence, the ESR were significantly decreased after 3 months, nine cases dropped to normal levels.Conclusion The advantage of this method is that it does not destroy the integrity of the peritoneal cavity, and more convenient to relesse ureter, even if the patient is obese.Particularly suitable for fibrous tissue were limited to lumbar vertebrae of 4,5.In order to avoid complications by long-term use of prednisone, patients take short-term low-dose prednisone plus long-term use of tamoxifen, that achieve good results.