融合性交叉异位肾伴旋转不良1例

患者男,47岁,因"尿频、尿急"就诊。超声于左肾区未见肾脏回声,于右肾下极见一个类似肾脏的结构;前列腺增大、回声欠均匀。超声诊断:交叉异位肾,前列腺增生。为明确交叉异位肾诊断,行腹部64排螺旋CT检查:轴位增强扫描及MPR图像均见左肾缺如,右肾下方可见与之呈相同强化特征的异位肾,右肾下极与异位肾上极之间相互融合,双肾盂扩张(图1A、B);CTA VR图像可见多条动脉由肾脏的两极及肾门进入双肾     

CT引导下经皮肾造口术的临床应用和技术探讨

目的 评价CT引导下经皮肾造口瘘术(PCN)的安全性和有效性,探讨相关技术要点和注意事项.方法 回顾性分析341例患者428例次CT引导下PCN的临床和手术资料,包括肾积水原因、穿刺次数、操作时间、成功率、并发症和临床效果.结果 428例次CT引导下PCN操作,单纯CT引导下完成420例次,占98.13%,结合X线透视下完成8例,占1.87%,总体成功率100%.肾盏穿刺次数:1次262例次,2次107例次,3次54例次,4次5例次,平均1.54次.操作时间15～43 min,平均27.43 min.所有患者PCN术后临床均显著好转.15例(4.40%)发生轻微并发症,包括肾周血肿3例、发热7例、导管早期脱出5例,无严重并发症发生.结论 CT引导下经皮肾造瘘术安全有效,注意技术要点、仔细操作能够减少并发症.     

罕少见内胚窦瘤2例

例1,患者女,48岁,左腰痛伴乏力、食欲减退1年.CT平扫显示:左肾正常结构消失,左肾上极及腹主动脉旁可见肿物,左肾上极软组织密度肿物,大小约4.5 cm×4.5 cm×3 cm,边缘钙化,实质部分平扫CT值33 Hu,边缘CT值242 Hu,增强扫描实质部分无明显强化;腹主动脉旁软组织密度肿物,大小约5 cm×2 cm×1.5 cm,平扫CT值45 Hu,增强扫描肿物中度强化,CT值68 Hu,侵及左侧腰大肌(图1),左肾静脉内充盈缺损.CT诊断:左肾癌侵及左侧腰大肌,左肾静脉瘤栓.术中见肿物位于左肾上极,大小约5 cm×5 cm×4 cm,质中等,左肾内侧腹主动脉旁可见7 cm×3 cm×2 cm肿物,与肾蒂及腹主动脉粘连,无法完全切除,左肾静脉有瘤栓.术后病理:内胚窦瘤.     

肾恶性纤维组织细胞瘤超声表现1例

患者男,51岁.外院超声发现左肾异常同声改变而来我院就诊.患者自述无肉眼血尿.体格检查无异常.实验室检查:血、尿常规及血生化检查均无明显异常.超声检查:左肾上极肾实质明显增厚,回声不均匀性减低;彩色多普勒血流显像示左肾上半部异常回声区内未见明显血流信号,下半部血流信号正常.超声提示:左肾上半部肾实质形态、同声及血流异常改变,考虑肾肿瘤所致可能性较大(图1).CT检查所见:平扫左肾上极可见类圆形肿块,密度不均,内见片状低密度区,增强可见病灶边缘强化明显,其内强化不明显,肾周筋膜未见明显增厚,CT提示左肾上极肿块,左肾肿瘤可能性大(图2).术中见左肾上极一大小9.0 cm×7.5 cm结节样肿物,切面灰白质脆,浸润达局部肾被膜及肾上腺组织,未累及输尿管断端,肾门血管内末见癌栓.免疫组化:AACT(+),CD68(+),CD99(+),SMA(+/- ),Vim(+/-),EMA(-),CD34(-),CK(-).病理结果:恶性纤维组织细胞瘤.     

腹部闭合性损伤的CT诊断（附30例分析）

目的 探讨腹部闭合性操损伤的CT表现特点。材料和方法 30例腹部闭合性损伤患者均于后24小时内行CT平扫,部分加做增强扫描。结合腹腔穿刺和手术所见对CT表现作回顾性分析。结果 CT平扫表现肝、脾、肾推挫裂伤20例;肝脾肾包膜下出血7例;小肠破裂2例;哨兵血块征20例;腹腔积血19例。增强扫描可使脏器挫裂伤显示更清楚。结论 CT能准确显示腹部脏器损伤的部位、范围和严重程度,监控病情,避免不必要的剖腹探查,提高保守治疗成功率。     

肾中间型上皮样血管内皮瘤1例

患者女性,33岁。左腰部疼痛1年半,外院CT示左肾占位性病变,左肾癌可能性大。入院后腹部彩超示左肾上极可见一个3.33 cm×2.87 cm的等回声实质性光团,包膜不完整,界限欠清,呈圆球形,不向肾表面凸出,内部回声欠均匀。CDFI示周围血管围绕,考虑为左肾上极实质性占位。临床诊断:左肾占位,左肾癌。于腹腔镜下行左肾肿瘤根治术。术中见左肾正常大小,表面光滑,剖开后见左肾上极有一灰白色肿块,大小2.5 cm×2 cm×1 cm,与周围组织界限清,质     

肾脏原发非霍奇金淋巴瘤1例报告

患者 ,男性 ,34岁 ,因左腰部疼痛伴肉眼血尿 1个月 ,收治我院。入院查体 :一般情况可 ,全身浅表淋巴结未触及肿大。心肺未见异常。腹软 ,肝脾未触及 ,左侧腹部轻压痛。双下肢无水肿。腹部CT检查 :左肾体积增大 ,肾实质内可见不规则肿块 6cm× 5cm大小 ,考虑肾癌可能。术前化验血常规、肝肾功能、胸片等未见异常。术中发现 :肿物位于左肾上极 ,无完整包膜 ,切面呈灰白色 ,肾门部见肿大淋巴结。术后病理 :左肾非霍奇金淋巴瘤 ,弥漫大B细胞型 ,浸透肾被膜 ,侵及左肾上腺 ,肾门淋巴结 2枚受累。免疫组化 :白细胞共同抗原 (LCA) (+) ,CD2 0 (…     

螺旋CT三维重建影像在标准通道经皮肾镜取石术中的临床应用

目的 探讨螺旋CT三维重建影像在标准通道经皮肾镜取石术中的应用价值.方法 对2008年1月～2009年3月26例复杂肾结石患者术前常规进行螺旋CT扫描及图像三维重建,确定肾孟肾盏结构、结石位置、最佳穿刺路径等,在B超引导下行标准通道经皮肾镜取石术.结果 26例患者行PCNL 28例侧,其中结石所在侧Brodel型肾脏22例侧,Hodson型肾脏6例侧.合并肾积水15例(57.69%).单通道手术23例,双通道手术3例.经肾上盏建立通道1例,经中盏23例、下盏5例.第12肋下穿刺16例次,第11肋间穿刺13例次.一期PCNL20例,结石总清除率75%,二期取石3例.中转开放手术2例.1例孤立肾肾结石合并重度肾积水者,结石寻找困难,因病情危重行经皮肾造瘘术.一期PCNL无术中、术后大出血需输血者,无胸膜、腹腔器官损伤等严重并发症.手术时间15～240min,平均(117±68)min.结论 螺旋CT三维重建能够为B超引导下的PCNL提供更加精确的穿刺径路,有助于减少手术出血,避免穿刺损伤周围脏器,提高结石清除率.     

超声诊断先天性肾积水合并肾损伤1例

患儿男 ,9岁。因左侧腹部撞伤 1d,腹部剧痛入院。患儿出生后 3个月查出患有先天性肾积水。超声检查显示 :左肾明显增大 ,集合系统分离 6 .8cm,实质区薄 ,上极偏腹中线侧见一直径约 2 .2 cm的裂口样回声。肾上极包膜下见范围约 6 .4 cm× 3.4 cm的液性暗区 ,该液区借裂口与肾盏肾盂相通 (图 1)。肾周探及最大厚约 0 .6 cm的液性暗区。超声诊断 :(1)左肾大量积水 ;(2 )左肾包膜下积液 (肾实质损伤 ) ;(3)肾周少量积液。超声引导下行左肾造瘘术 (图 2 ) ,引流出黄褐色液体 ,镜检红细胞 ( )。图 1　肾脏积水声像图　　讨论　暴力性损伤是小儿闭…     

不典型肾盂癌超声诊断1例

患者女 ,76岁 ,2年前曾在外院行体外碎石术。我院B超检查 ,左肾中上极未见正常结构显示 ,被一 7.2cm× 6 .2cm混合回声区取代 ,无明显包膜 ,以无回声为主 ,内间以低回声 ,低回声后方靠肾门处可见 2 .5cm× 1.0cm强光环 ,后方声影不明显 (见图 ) ,中下极肾盂肾盏轻度扩张。于下极见一 0 .8cm× 0 .6cm强光团伴声影。超声诊断 :①左肾占位性病变 ?②结核性 ?③积水 (损伤后感染 ) ?④左肾结石 ?CT注射对比剂后扫描示 :左肾上极肿块于动脉期及延迟期均呈不均匀强化 ,肿块大小约 5cm× 6 .5cm ,连续 6个层面左右。肿块向肾盂内凸出 ,其内侧缘…     

Bilateral renal milk of calcium masquerading as nephrolithiasis in patients with spinal cord injury

Milk of calcium is a viscous colloidal suspension of calcium carbonate, calcium phosphate, or calcium oxalate, or a mixture of these compounds. The calcific material gravitates to the dependent portion of a cystic cavity. Crescent- or hemisphere-shaped calcium density with a sharp horizontal upper border at the milk of calcium-clear fluid interface confirms the diagnosis. Bilateral milk of calcium in the renal pelvis or in dilated calyces is very rare and has not been reported in patients with spinal cord injury. A 63-year-old male patient with T-10 paraplegia presented with recurrent urinary tract infections. X-ray of the kidneys, taken with the vertical beam while the patient lay supine, revealed a poorly defined opacity overlying the lower pole of the right kidney. Findings on ultrasonography of the kidneys were interpreted as a large, staghorn-type calculus in the dilated lower pole calyx of the right kidney. Because x-ray of the kidneys showed a poorly defined opacity overlying the lower pole of the right kidney, milk of calcium was suspected, and computed tomography (CT) of the kidneys was performed. Calcific debris with horizontal layering in the lower pole calyces of both kidneys was seen; this confirmed the diagnosis of milk of calcium. A 62-year-old female patient with C-7 tetraplegia underwent ileal conduit urinary diversion. Subsequently, she developed calculi in the right kidney, which were treated with shock wave lithotripsy. Follow-up x-ray revealed faintly opaque shadows with indistinct margins in the region of both kidneys. Intravenous urography showed cortical thinning at the upper poles and blunting of the calyces, suggestive of chronic pyelonephritis. The right renal pelvis was bulky, and bilateral renal calculi were diagnosed during ultrasonography; however, the presence of faintly radio-opaque shadows with indistinct margins raised suspicions of renal milk of calcium. A CT scan of the kidneys, which was performed in the supine and subsequently in the prone position, revealed gravity-dependent layering of calcific material in the pelves of both kidneys and in the midpole calyces of the right kidney, thus confirming the diagnosis of milk of calcium. In conclusion, CT scan of the kidneys confirmed the diagnosis of bilateral renal milk of calcium, a very rare entity in patients with spinal cord injury. Awareness of typical and unique features of milk of calcium during imaging enables physicians to recognize renal milk of calcium and to differentiate it from nephrolithiasis, thereby avoiding unwarranted interventions such as shock wave lithotripsy or endoscopic procedures.     

Anterior position of the lower pole of the right kidney: Potential confusion with right upper quadrant mass

A group of patients with anterior position of the lower pole of the right kidney were examined with ultrasound to evaluate a palpable right upper quadrant mass. After it was determined, with the use of ultrasound, that the palpable mass represented the kidney, no further evaluations were necessary. This appearance is seen fairly often in normal individuals and should be considered a normal variant. The possible anatomic explanation for this appearance is discussed.     

Interposition of the colon between the kidney and the psoas muscle: a normal anatomic variation studied by CT

The position of the bowel in the pararenal space was examined in relation to the kidney and the psoas muscle in 1203 abdominal computed tomographic (CT) examinations. The ascending colon was found between the lower kidney pole and the psoas muscle in 1.7% and the descending colon in 0.7% of the patients. This variation appeared more frequently in women, young adults, and individuals with less intrabdominal fat. Lateral displacement of the lower kidney pole was observed in 40% of the patients with this normal variation. These findings may be of value when interpreting urographic and abdominal CT examinations.     

超声标记肾脏体表投影测量肾脏移动度

目的 观察基于超声标记肾脏体表投影测量肾脏移动度新方法的可行性。方法 纳入338名参加2021年度空军飞行学员医学选拔定选阶段的健康应征学生,以超声定位仰卧及直立位下双肾上、下极、肋弓下缘及髂前上棘体表投影,测量双肾长度、肾脏直接移动度及间接移动度。以组内相关系数(ICC)评价体表投影法与超声常规法测量肾脏长度的一致性,以及体表投影法所测双肾上极相对于肋弓下缘的间接移动度与下极相对于肋弓下缘的间接移动度的一致性,比较肾脏上/下极间接移动度与直接移动度的差异。结果 2种方法测量仰卧、直立位下肾脏长度的一致性较好(ICC均＞0.70,P均＜0.001)。体表投影法所测左、右肾脏间接移动度均大于直接移动度(P均＜0.05)。体表投影法所测双肾上极相对于肋弓下缘的间接移动度与下极相对于肋弓下缘的间接移动度测值一致性最佳,ICC分别为0.911、0.923(P均＜0.001)。结论 超声标记肾脏体表投影测量肾脏移动度方法可行;以肾脏下极与肋弓下缘作为标准定位点准确、合理。     

The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle

ABSTRACT

Objectives: Prudent dry needling techniques are commonly practiced with the intent to avoid large neurovascular structures, thereby minimizing potential excessive bleeding and neural injury. Patient position is one factor thought to affect the size of the safe zone during dry needling of some muscles. This study aimed to compare the size of the needle safe zone of the iliacus muscle during two different patient positions using ultrasound imaging.

Methods: The distance from the anterior inferior iliac spine (AIIS) to the posterior pole of the femoral nerve was measured in 25 healthy participants (11 male, 14 female, mean age = 40) in both supine and sidelying positions using a Chison Eco1 musculoskeletal ultrasound unit. The average distance was calculated for each position and a two-tailed, paired t-test (α < 0.05) was used to examine the difference between positions.

Results: The mean distance from the AIIS to the posterior pole of the femoral nerve was statistically greater with participants in the sidelying position (mean[SD] = 35.7 [6.2] mm) than in the supine position (mean[SD] = 32.1 [7.3] mm, p < .001).

Discussion: Although more study is needed, these results suggest that patient positioning is one of several potential variables that should be considered in the optimization of patient safety/relative risk when performing trigger point dry needling.

Level of Evidence: Level 4 (Pre-Post Test)     

Laparoscopic resection aided by preoperative 3‐D CT angiography for rectosigmoid colon cancer associated with a horseshoe kidney: A case report

We herein report a case of laparoscopic high anterior resection with D3 lymph node dissection for rectosigmoid colon cancer with a horseshoe kidney. A 65‐year‐old Japanese man referred to our hospital for rectosigmoid colon cancer was found to have a horseshoe kidney on a CT scan. On 3‐D CT angiography, an aberrant renal artery was visualized feeding the renal isthmus that arises from the aorta just below the root of the inferior mesenteric artery (IMA). Laparoscopic anterior rectal resection with D3 lymph node dissection was performed. During the operation, the IMA, left ureter, left gonadal vessels and hypogastric nerve plexus could be seen passing over the horseshoe kidney isthmus. With the aid of preoperative 3‐D CT angiography, the root of the IMA was identified on the temporal side of the isthmus and divided safely just above the hypogastric nerve. As a horseshoe kidney is often accompanied by aberrant renal arteries and/or abnormal running of the ureter, 3‐D CT angiography is useful for determining the location of these structures and avoiding intraoperative injury.     

不同呼吸状态对超声引导经皮肾穿活检成功率的影响

目的就2种不同呼吸状态对超声引导经皮肾穿的影响进行比较,并对产生此种影响的因素进行分析.方法穿刺点选右肾下极外侧,分别取深吸气末屏气及平静吸气后屏气2种状态.结果深吸气末屏气状态,肾脏位置强制性大幅下移,下极受力后这种脆弱平衡状态被迅速打破,致使肾脏快速上移.同时肾脏长轴与人体长轴的角度增大,致肾穿时的合力点下移偏离进针方向.俯卧位腹部垫高的体位及腰大肌上窄薄下宽厚的解剖特点,使这一区域的下方较狭小,过度下移的肾脏强行挤进这一空间后,在受到穿刺针的作用力时,易向受力较小、空间较大的上方移动.不易控制呼吸.而平静吸气状态,肾脏位置下移少,肾蒂受力小,张力较低.肾脏长轴与人体长轴的角度小,处于较稳定的平衡状态.患者易控制呼吸.结论深吸气末屏气状态易造成肾脏位置的上移或穿刺点的下移,致穿刺失败.平静吸气后屏气状态受上述因素影响较小,成功率较高.     

不同体位对妇科肿瘤调强放射治疗剂量学和急性放射性肠炎的影响

目的 探讨妇科肿瘤调强放射治疗（IMRT）采用俯卧位或仰卧位对危及器官剂量学及放射治疗不良反应的影响,优化IMRT体位固定方式。方法 选择42例宫颈癌及子宫内膜癌IMRT患者,按体位固定方式分为俯卧组23例与仰卧组19例。在相同条件下勾画靶区和危及器官并进行治疗计划优化,比较2组患者危及器官剂量-体积关系,分析2组患者急性放射性肠炎的发生情况。 结果 俯卧组小肠接受15~50 Gy照射剂量的体积均小于仰卧组,其中2组接受20、30、40 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组患者结肠接受30、40、45 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组膀胱接受15~50 Gy照射剂量的体积比仰卧组稍升高,但仅接受20 Gy照射剂量的体积在组间比较差异有统计学意义（P < 0.05）。2组患者直肠及股骨头的剂量-体积关系比较差异无统计学意义（P > 0.05）。俯卧组患者消化不良、恶心、呕吐、腹痛和腹泻等急性放射性肠炎的发生率低于仰卧组,但组间比较差异无统计学意义（P均> 0.05）。 结论 妇科肿瘤IMRT采用俯卧位可降低小肠及结肠接受照射剂量。     

肝裸区与腹膜后间隙右份关系的临床CT研究

目的研究肝裸区与腹膜后间隙右份的通连关系,并对来源于右肝、肾上腺的较大肿块的ＣＴ定位诊断进行初步探讨。方法回顾性观察３８例ＣＴ表现,其中右肾旁前间隙积液１６例,右肾周间隙积液３例,右肾上腺肿块１３例,右肝肿块６例。肿块直径均大于５ｃｍ。结果１．本组右肾前、后筋膜均未在肾上极以上平面显示。２．右肾旁前间隙积液上界未超过肾上极平面。３．右肾周间隙内积液向上蔓延至肝裸区。肝裸区附近肝脓肿流入右肾周间隙,     

不同体位肺保护通气方式对肺内/外源性急性呼吸窘迫综合征犬肾上腺髓质素的影响

目的观察在仰卧位和俯卧位条件下小潮气量＋呼气末正压（PEEP）通气对急性呼吸窘迫综合征（ARDS）模型犬肺不同部位（肺上区肺尖叶、肺下区腹侧肺心叶和肺下区背侧肺膈叶）支气管肺泡灌洗液（BALF）中肾上腺髓质素（ADM）的作用，以评价不同体位肺保护通气方式对肺内／外源性ARDS（ARDSp／ARDSexp）的抗炎作用机制。方法健康雄性杂种犬24只，随机分为ARDSp仰卧位通气组、俯卧位通气组以及ARDSexp仰卧位通气组、俯卧位通气组，每组6只。静脉注射油酸制备ARDSexp动物模型；气管内注入十六烷磺基丁二酸钠盐制备ARDSp动物模型。动态观察不同卧位条件下小潮气量＋PEEP对ARDS模型犬氧合指数和肺不同部位BALF中ADM的变化。结果肺损伤后ARDS犬氧合指数明显下降；ARDSp模型犬肺尖叶和肺心叶BALF中ADM水平明显高于ARDSexp模型；俯卧位条件下肺保护性通气对ARDS模型犬具有更好的治疗效果，氧合指数改善更为明显，ADM释放受到抑制。结论ARDSexp和ARDSp对肺不同部位ADM释放的影响具有明显差异；俯卧位＋小潮气量＋PEEP通气模式对ARDSexp和ARDSp均具有良好的治疗效果。