超声造影在经皮肾镜取石术后出血监测中的应用

目的 探讨超声造影（CEUS）在经皮肾镜取石术（PCNL）后出血监测中的应用价值。方法 收集2017年8月－2020年9月该院泌尿外科完成PCNL的患者1 141例,回顾性分析22例根据临床病情需要行床旁CEUS并接受超选择性肾动脉栓塞术的患者的临床资料。结果 1 141例PCNL后因肾出血经保守治疗无效需行超选择性肾动脉栓塞术的共22例,发生率为1.93%。CEUS常规应用于PCNL后监测,术后第3天发现肾出血1例,术后第5天发现肾出血12例,术后第8天发现肾出血4例,术后第11天发现肾出血3例,术后第14天发现肾出血1例;1例术后第1天发生严重出血行介入失败,转开放手术。CEUS显示：肾假性动脉瘤15例,肾假性动脉瘤合并动静脉瘘5例,动静脉瘘1例,肾包膜下弥漫出血1例,与数字减影血管造影（DSA）检查相符。结论 CEUS可随时、重复监测PCNL后的出血情况,明确肾内有无假性动脉瘤和（或）动静脉瘘,为及时采用超选择性肾动脉栓塞术治疗肾出血提供了临床诊断和治疗依据,并可作为患者术后随诊检查的首选。     

超声造影在肾损伤血肿和活动性出血诊断中的应用

目的 探讨超声造影在肾损伤血肿和活动性出血诊断中的应用价值.方法 对28例肾损伤患者分别行常规超声和超声造影检查,其中肾穿刺活检术后损伤24例,闭合性肾损伤4例,计算两种方法对肾损伤血肿及活动性出血的检出率,所有病例均经CT检查或超声随访检查证实.结果 常规超声对肾血肿的检出率为67.86%(19/28),超声造影对肾血肿的检出率为92.86%(26/28),高于常规超声(P＜0.05),且造影后血肿范围更明确.常规超声难以诊断肾损伤血肿内的活动性出血,超声造影诊断26.92%(7/26)肾血肿伴活动性出血.超声造影特征为肾血肿形成时,血肿区始终无造影剂进入;肾血肿伴活动性出血时,造影剂自受损血管溢出,形成不规则的异常增强区.结论 超声造影有助于诊断肾损伤血肿,准确计算血肿范围和判断活动性出血,对发现肾穿刺活检术后合并的血肿及出血具有特殊应用价值.     

超声造影诊断直肠癌前哨淋巴结

目的 探讨CEUS在直肠癌前哨淋巴结(SLN)诊断中的价值。方法 46例直肠癌患者中,选取接受直肠癌手术,且术中CEUS定位检测SLN的患者42例,观察SLN增强情况。术后常规病理学检测所有淋巴结,并与CEUS结果比较。结果 CEUS对SLN的检出率为91.30%(42/46),CEUS判定直肠癌SLN的敏感度87.50%(21/24)、特异度90.47%(38/42)、准确率89.39%(59/66)。结论 CEUS定位直肠癌SLN具有较好的效果,且增强方式可初步判断其是否发生转移,具有一定的临床应用价值。     

3.0T 三维动态增强MR血管成像诊断脊髓血管畸形

目的 评价3.0T MR脊髓三维动态增强MR血管成像(CE-MRA)诊断脊髓血管畸形的临床价值。方法 对临床及MR平扫疑诊脊髓血管病的14例患者行CE-MRA检查,其中13例于3~5天内接受DSA检查,6例接受手术治疗,对比分析MRA与DSA及手术结果。结果 CE-MRA诊断8例为硬脊膜动静脉瘘(SDAVF),5例为髓周动静脉瘘(PMAVF),1例为脊髓动静脉畸形(SCAVM);与DSA检查结果对照,14例中,MRA可以准确判断11例的供血动脉及瘘口。结论 3.0T 3D-CE-MRA可快速、无创、清晰地显示脊髓血管畸形的供血动脉及瘘口,在诊断脊髓血管畸形、协助制定治疗方案及术后随访等方面具有重要价值。     

320排CTA诊断脑动静脉畸形破裂出血

目的 探讨320排CTA在脑动静脉畸形(AVM)破裂出血诊断中的价值。 方法 收集接受颅脑CTA检查并经病理和(或)DSA证实的脑AVM破裂出血患者45例,均接受增强动态容积多期CT扫描;利用sub/add软件得到动脉期和静脉期减影数据,对其进行VR、MIP,获得仿真脑动脉、静脉减影图像;回顾性分析原始及重建图像。21例同时接受CTA与DSA检查,对CTA与DSA显示的供血动脉与引流静脉的数目进行统计学分析。 结果 CTA 检出44例脑AVM,其中幕上39例(颞叶最多,8例,顶叶次之,7例),幕下5例,均位于小脑;漏诊1例。AVM破裂出血表现为脑实质血肿41例,蛛网膜下腔出血4例;单条动脉供血37例,2条动脉供血7例;引流至浅表静脉窦29例,引流至深静脉15例。CTA与DSA对AVM供血动脉、引流静脉的显示差异无统计学意义(P>0.05)。 结论 320排CTA可作为诊断脑AVM破裂出血安全、准确的首选影像学检查方式。     

超声诊断胰腺神经内分泌肿瘤

目的 探讨胰腺神经内分泌肿瘤的超声及CEUS表现。方法 回顾性分析经手术病理证实的13例胰腺神经内分泌肿瘤的常规超声及CEUS表现。结果 13例均接受常规超声,7例接受CEUS检查。13例中,神经内分泌瘤8例,神经内分泌癌5例,均呈低回声,肿瘤边界较清晰,CDFI见肿瘤内部丰富线状彩色血流。肿瘤位于胰头5例,胰体5例,胰尾3例;直径1.6~6.0 cm;9例为实性,4例为囊实性。7例接受CEUS的患者中,3例为神经内分泌瘤,4例为神经内分泌癌,与胰腺实质相比较均表现为早期或同步增强,达峰时呈较胰腺实质高或等增强,减退早于胰腺实质,呈低增强。结论 胰腺神经内分泌肿瘤超声表现为边界清晰低回声占位、伴有丰富血流,CEUS表现为早期或同步增强,达峰时呈富血供表现,有助于鉴别诊断。     

超声造影评估宫颈癌化疗疗效

目的 探讨CEUS在宫颈癌化疗疗效评估中的应用价值。 方法 对42例接受化疗的宫颈癌患者于化疗前及化疗后2周行CEUS检查,应用时间-强度曲线分析病灶造影剂到达时间(AT)、达峰时间(TTP)和峰值强度(PI)。采用妇科检查结合MRI评价化疗疗效,比较不同疗效间CEUS检查结果的差异。 结果 29例治疗有效,病灶造影剂AT及TTP较化疗前延长(P均<0.05),PI较化疗前下降(P>0.05);13例治疗无效,病灶造影剂AT及TTP较治疗前缩短(P均>0.05),而PI较治疗前明显增高(P<0.05)。 结论 应用CEUS技术检测宫颈癌化疗前后肿瘤血流灌注的变化可反映化疗疗效,为疗效评估提供可靠依据。     

CEUS鉴别诊断肾透明细胞癌和嫌色细胞癌

目的 探讨CEUS对肾透明细胞癌（CCRCC）和嫌色细胞癌（ChRCC）的鉴别诊断价值。方法 收集接受肾脏CEUS检查并经术后病理证实为CCRCC的患者75例及ChRCC的患者26例。观察CCRCC和ChRCC的增强方式、增强程度、增强形态、假包膜征及病灶对局部淋巴结、肾包膜及肾静脉的侵犯情况,并绘制时间-强度曲线,获得校正的始增时间（ΔAT）、达峰时间（ΔTTP）和峰值强度（ΔPI）,进行统计学分析。结果 CCRCC多表现高增强（41/75,54.67%）、弥漫性增强（54/75,72.00%）和不均匀增强（58/75,77.33%）,56.00%（42/75）有假包膜征。ChRCC多表现为低增强（19/26,73.08%）、向心性增强（14/26,53.85%）和均匀增强（17/26,65.38%）,61.54%（16/26）有假包膜征。CCRCC与ChRCC增强程度、增强方式及增强形态的差异均有统计学意义（P均<0.05）,假包膜征检出率的差异无统计学意义（P>0.05）。CCRCC的ΔAT和ΔTTP与ChRCC比较,差异均无统计学意义（P均>0.05）,而CCRCC的ΔPI明显高于ChRCC（P<0.001）。以ΔPI=0.05%为阈值鉴别诊断CCRCC和ChRCC的准确率最高,其敏感度为82.70%,特异度为100%,ROC曲线下面积为0.969。CCRCC出现肾周和（或）肾窦脂肪受累和肾门和（或）腹膜后淋巴结转移的百分率均高于ChRCC（P均<0.05）。结论 CCRCC和ChRCC具有不同的CEUS特征,有助于二者的鉴别诊断。     

影像学诊断儿童肾盏或肾盂憩室

目的 探讨影像学检查诊断儿童肾盏或肾盂憩室的价值。方法 回顾性分析19例肾盏或肾盂憩室患儿的影像学表现,并进行对比分析。结果 19例中,18例接受肾动态显像检查、1例接受全身骨显像均诊断为肾盏或肾盂憩室;8例接受CT检查,其中4例诊断为肾盏或肾盂憩室,4例诊断为囊肿;16例接受CT检查,7例诊断为囊肿、肾盏或肾盂憩室,9例为囊肿;5例接受MR检查,3例诊断为囊肿、肾盏或肾盂憩室,2例为囊肿。结论 肾动态显像较其他影像学检查方法能直观地显示放射性显像剂在肾脏内的摄取及排泄过程,诊断肾盏或肾盂憩室的敏感性更好。     

超声动态观察新生儿室管膜下出血

目的 观察新生儿室管膜下出血(SEH)的超声表现.方法 对42 例SEH新生儿进行定期颅脑超声检查及随访,并分析其影像学资料.结果 超声显示在侧脑室前角外下方及丘脑尾状核沟呈回声增强区,未侵入侧脑室.在出血初始阶段,病灶呈中高度回声;出血稳定期回声渐强、边界更清;吸收期,病灶中央出现低回声而边缘仍为高回声,并逐渐形成透声差、有分隔的厚壁囊腔;随后病灶中央出现无回声区,最终形成出血后室管膜下囊腔.在出院后追踪随访显示,4.76%(2/42)、54.76%(23/42)、23.81%(10/42)的患儿分别在出血1个月、2个月、3个月囊腔消失,3个月内病灶基本吸收的患儿占83.33%(35/42).结论 颅脑超声具有早期诊断SEH的优势,可动态观察病程变化、评估出血转归.     

Predictors of perirenal haematoma post-percutaneous ultrasound-guided renal biopsy

ObjectiveTo perform a prospective study to determine the risk factors associated with perirenal haematoma development after percutaneous renal biopsy (PRB).MethodsThis multivariate prospective study collected demographic and clinical data from all consecutive adult patients that underwent real-time ultrasound-guided PRB of native kidneys. All biopsies were performed by two well-trained ultrasound physicians using 16G biopsy needles. Routine renal ultrasounds were performed within 12–24 h after biopsies in order to observe post-biopsy perirenal haematoma formation. Patients were stratified based on the occurrence of post-biopsy haematoma development.ResultsThis prospective study enrolled 218 patients and stratified them into a haematoma group (n = 126) and a non-haematoma group (n = 92). Binary logistic regression analysis identified female patients (odds ratio [OR] 1.990; 95% confidence interval [CI] 1.125, 3.521), patients with a body mass index (BMI) ≥28 kg/m² (OR 2.660; 95% CI 1.097, 6.449) and patients with immediate post-biopsy active bleeding (IPAB) (OR 2.572; 95% CI 1.422, 4.655) as being more likely to have perirenal haematoma after real-time ultrasound guided PRB of native kidneys.ConclusionFemale sex, a BMI ≥28 kg/m² and IPAB were risk factors for perirenal haematoma after real-time ultrasound-guided PRB of native kidneys.     

肾破裂出血的CT影像分析（附36例报告）

评价肾出血的CT表现及诊断价值。方法：36例病人中，肾创伤出血28例，25例平扫，3例平扫加增强，发现肾钝性创伤25例、肾穿刺后出血3例；肾肿瘤出血8例，均行平扫，其中肾细胞癌5例，错构瘤3例。结果 36例肾出血CT影像提示为：肾内出血，肾包膜下血肿、肾周血肿及伴风膜囊血肿等。结论 CT检查能准确估计肾出血的原因、程度、范围并能发现其它合并症，为临床选择治疗方案提供重要依据。     

Superselective transcatheter arterial embolization to control renal hemorrhage after partial nephrectomy for renal tumors: A report of 9 cases and a literature review

ObjectiveThis study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methodsA total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.ResultsTechnical success was achieved in all patients; however, 3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage. No serious complications occurred during the follow-up.ConclusionsSuperselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy. To improve the success rate of surgery, attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.     

CEUS诊断肾脏占位性病变

目的 探讨CEUS在肾脏占位性病变中的应用价值。方法 对67例肾脏占位性病变患者术前行常规超声及CEUS检查,观察造影增强特征,并对其中40例肾透明细胞癌（CCRCC）和14例肾血管平滑肌脂肪瘤（AML）造影增强特征进行比较,并分析时间-强度曲线定量参数,包括峰值强度（IMAX）、上升时间（RT）、达峰时间（TTP）及平均渡越时间（mTT）。结果 CCRCC和AML的CEUS增强模式、增强强度、增强均匀度和假包膜征差异均有统计学意义（P均< 0.01）。CCRCC的IMAX高于AML,RT和mTT均早于AML （P < 0.05）。CEUS定性诊断恶性肾脏占位性病变的敏感度91.49%（43/47）,特异度75.00%（15/20）,准确率86.57%（58/67）。结论 CEUS结合造影定量分析软件有助于诊断和鉴别CCRCC与AML。     

Spontaneous perirenal hemorrhage (Wunderlich syndrome): An analysis of 28 cases

Introduction

This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]).

Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report

BACKGROUNDSpontaneous renal rupture is a rare disease in the clinic. The causes of spontaneous renal rupture include extrarenal factors, intrarenal factors, and idiopathic factors. Reports on infection secondary to spontaneous renal rupture and the complications of spontaneous renal rupture are scarce. Furthermore, there are few patients with spontaneous renal rupture who present only with fever.CASE SUMMARYWe present the case of a 52-year-old female patient who was admitted to our hospital. She presented only with fever, and the cause of the disease was unclear. She underwent a contrast-enhanced computed tomography (CT) scan, which showed that the left renal capsule had a crescent-shaped, low-density shadow; the perirenal fat was blurred, and exudation was visible with no sign of calculi, malignancies, instrumentation, or trauma. Under ultrasound guidance, a pigtail catheter was inserted into the hematoma, and fluid was drained and used for the bacterial test, which proved the presence of Klebsiella pneumoniae. Two months later, abdominal CT showed that the hematoma was absorbed, so the drainage tube was removed. The abdominal CT was normal after 4 mo.CONCLUSIONSpontaneous renal rupture due to intrarenal factors causes a higher proportion of shock and is more likely to cause anemia.     

对比超声造影与增强CT评价射频凝固闭合性肝外伤疗效的实验研究

目的 对比研究超声造影与增强CT评估射频凝固闭合性肝外伤的疗效.方法 采用自制小型撞击器撞击8头健康家猪肝区,建立闭合性肝外伤伴活动性出血模,分为治疗组(6头)和对照组(2头).治疗组在超声造影引导下进行射频凝固治疗,射频治疗前、后进行超声造影和增强CT检查.对照组撞击后行超声造影和增强CT检查,不进行任何治疗.实验结束后,剖腹验证疗效并将检查结果与病理进行对照.结果 治疗前超声造影和增强CT均检出治疗组和对照组全部动物模型的肝实质损伤病灶,超声造影检出全部猪肝活动性出血信号,增强CT检出6头猪肝活动性出血.射频治疗后,治疗组超声造影及增强CT均末检出肝活动性出血.对照组1头在撞击后30分钟内因失血过多死亡,另1头在撞击后1 h超声造影及增强CT均可见肝活动性出血.结论 超声造影与增强CT均能准确诊断闭合性肝外伤并对射频凝固止血疗效准确评估.     

Bilateral hematoma after tubeless percutaneous nephrolithotomy for unilateral horseshoe kidney stones: A case report

BACKGROUNDBilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones, and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous nephrolithotomy (PCNL) for unilateral horseshoe kidney calculi.CASE SUMMARYA 32-year-old man was admitted to our hospital because of repeated intermittent hematuria for 10 years. Plain abdominal computed tomography (CT) scan revealed calculi in the horseshoe kidney; the largest being 2 cm in diameter. Tubeless PCNL was performed to remove the stones. Three days after the operation, the patient was discharged in a stable situation. Three days after discharge, the patient presented to our emergency department because of right low back pain and vomiting. Emergent CT scan revealed subcapsular and perirenal hematocele and exudates in both kidneys. Ultrasound-guided puncture and drainage of perirenal effusion were performed. After the temperature stabilized, the patient received low-pressure injection of urokinase 100000 U for 3 d. His routine blood indexes and the renal function returned to normal in 3 wk. CT re-examination 3 mo after lithotripsy showed that the subcapsular and perirenal hematoma and exudates in both kidneys were significantly absorbed as compared with those before. The patient was followed up for 1 year, during which no flank pain or hematuria recurred.CONCLUSIONThis is the first case report on the formation of bilateral hematoma following tubeless PCNL for unilateral horseshoe kidney calculi.