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1.
目的探讨排尿性膀胱尿道造影(micturating cystourethrography,MCU)筛查儿童原发性膀胱输尿管反流(vesi-coureteric reflux,VUR)的意义。方法选择40例经99Tcm-二巯基丁二酸(DMSA)显像后肾脏放射性摄取缺损或减少的尿路感染(urinary tract infection,UTI)患儿行MCU检查,依据国际反流性肾病协会提出的VUR分级标准评价MCU诊断结果。结果 40例MCU检查诊断原发性VUR 16例,检出率为40.0%,其中双侧9例,单侧7例;男8例,女8例;年龄<1岁13例。MCU检查共检出VUR 25个肾输尿管单位,其中Ⅱ级反流2支(8.0%),Ⅲ级反流5支(20.0%),Ⅳ级反流12支(48.0%),Ⅴ级反流6支(24.0%)。结论对UTI患儿进行规范的MCU检查可为原发性VUR诊断和治疗提供客观依据。  相似文献   

2.
超声造影对小儿膀胱输尿管反流诊断价值的初步探讨   总被引:2,自引:0,他引:2  
目的 评价排尿膀胱尿道超声造影检查对小儿膀胱输尿管反流(VUR)的诊断价值.方法 应用对比脉冲序列超声造影技术对53例反复尿路感染的患儿进行超声造影检查,观察膀胱、输尿管及肾的声像图表现,用五级法分析评价,并以排尿膀胱尿道造影术(VUCG)对照.结果 53例患者中超声造影检出19例(36个肾输尿管单位),VCUG检出18例(34个肾输尿管单位),超声造影及VCUG对VUR的分级检出一致性为31个肾输尿管单位,阴性检出一致性为69个肾输尿管单位.超声造影和VCUG对VUR的检查有很高的一致性(Kappa值=0.909).结论 超声造影能敏感检测出VUR,同时无放射性,重复性好,可作为VUR的首选检查方法之一.  相似文献   

3.
相对安全膀胱容量间歇导尿法保护上尿路的临床研究   总被引:1,自引:0,他引:1  
目的探讨相对安全膀胱容量间歇导尿法防治脊髓损伤患者膀胱输尿管返流的疗效和适应证。方法 23例男性完全性脊髓损伤患者,术后1个月~11年,年龄在7~45岁,其中对照组15例为无膀胱输尿管返流(VUR),其他8例存在VUR,3例轻度返流,5例重度返流,依据患者相对安全膀胱容量的大小结合超声设备,对患者进行间歇导尿,每周测相对安全膀胱容量1次,治疗观察期2年以上。期间给予扩大膀胱容量的药物和方法以扩大膀胱容量。结果入院时无膀胱输尿管返流患者均未出现VUR;轻度返流者出现返流输尿管逐渐变细,返流程度逐渐减轻,直至返流消失;重度返流者返流未出现缓解。结论相对安全膀胱容量间歇导尿法对膀胱输尿管返流具有一定的防治作用。  相似文献   

4.
膀胱输尿管反流(VUR)是一种常见的尿路畸形,严重者可致肾脏损害。重度反流以手术纠正为主,轻、中度反流以低剂量抗生素预防尿路感染为主。本研究对膀胱输尿管反流患儿进行临床分析和随访,现报告如下。1资料与方法选取2009年1月—2011年12月本院尿路感染控制后行X线排尿期膀胱尿路造影(MCU)诊断为VUR的患儿42例,其中首次发生尿路感染者19例,反复尿路感染者37例。  相似文献   

5.
目的 评价排泄性尿路超声造影(CeVUS)用于输尿管膀胱再植术治疗儿童膀胱输尿管反流(VUR)的价值。方法 纳入16例接受气膀胱腹腔镜输尿管膀胱再植术治疗VUR的患儿,于术前和术后6、12及18个月采用CeVUS评估反流程度,并与排泄性膀胱尿路造影(VCUG)诊断结果对比,采用Kappa检验评价二者诊断分级及评价疗效的一致性。结果 术前和术后6、12及18个月CeVUS分级诊断VUR的敏感度、特异度、准确率、阳性预测值及阴性预测值均较高;与VCUG分级诊断及评价疗效的一致性均极高(P均>0.05)。结论 CeVUS可用诊断儿童VUR,特别适用于术后需多次复查的患儿。  相似文献   

6.
目的 探讨排泄性尿路超声造影(CeVUS)在诊断儿童膀胱输尿管反流(VUR)及肾内反流(IRR)中的价值,评估IRR与年龄、性别和VUR分级之间的关系。方法 回顾性收集怀疑VUR行CeVUS检查的患儿。所有患儿均行CeVUS检查,分析造影图像,记录反流级别、有无IRR、年龄和性别等资料。结果 在319例患儿中CeVUS检出VUR 138例,其中IRR有59例(42.8%)。IRR患儿年龄中位数为7(2~84)个月,而无IRR年龄中位数为16(1~108)个月(P<0.05)。共有VUR肾输尿管单位202个,其中IRR 77个,IRR在各级别VUR的检出率分别为Ⅱ级5.0%(2/40)、Ⅲ级34.7%(26/75)、Ⅳ级66.2%(43/65)、Ⅴ级40.0%(6/15)。结论 CeVUS可用于儿童VUR及IRR的诊断,IRR多见于Ⅳ级VUR和1岁以内的患儿。  相似文献   

7.
膀胱输尿管反流(VUR)与儿童泌尿道感染密切相关。排泄性尿路超声造影(CeVUS)是诊断儿童VUR的一种安全且可靠的影像学检查方法。本文主要就CeVUS在评估儿童VUR方面的研究进展做一综述。  相似文献   

8.
回顾性分析我院2004年1月-2012年12月收治的29例经排泄性膀胱尿路造影确诊的膀胱输尿管反流患儿临床资料。29例膀胱输尿管反流患儿中, MCU显示单侧异常25例,双侧均异常4例。经过治疗,25例好转出院,3例治疗后要求出院,1例放弃,随访6个月及以上,22例预后好,7例仍有反复泌尿系感染发生。男性患儿,反复泌尿系感染,年龄〈3岁者发生VUR的可能性大,婴幼儿VUR发生级别相对较高,双侧出现率高,无创性B超可作为常规筛查手段,3岁以下泌尿系感染患儿应及时行MCU,级别低VUR可内科保守治疗,级别高VUR应早期手术。  相似文献   

9.
目的初步探讨降钙素原对儿童尿路感染伴膀胱输尿管反流(VUR)的诊断价值及其与反流严重程度的关系。方法收集2011年1月至2012年3月该院所有连续就诊并诊断为首次发生尿路感染的患儿的降钙素原(PCT)、C反应蛋白(CRP)、尿液细菌培养、泌尿系统B超、排尿期膀胱尿道造影(VUCG)等结果。以VUCG作为VUR与非VUR的分组标准及VUR分级标准。结果共146例尿路感染患儿纳入研究,其中VUR患儿51例(占34.9%),VUR患病年龄、性别比例差异无统计学意义(P>0.05)。VUR组的PCT、CRP水平高于非VUR组(P<0.05),ROC曲线显示PCT诊断性能优于CRP。高PCT水平(≥0.5ng/mL)与VUR的级别密切相关(优势比为5.5,95%置信区间2.3~12.9),且与轻度、中度VUR均密切相关(优势比分别为4.6、9.1,95%置信区间分别为1.8~11.7、1.4~61.7)。结论 PCT对于判断是否存在膀胱输尿管反流具有一定的临床价值,可作为预测反流级别的独立指标,可能有助于减少不必要的VUCG。  相似文献   

10.
目的探讨患儿膀胱输尿管反流(VUR)的临床特点及其转归,为临床诊治提供指导。方法回顾分析该院VUR患儿临床经过特点、影像学改变、排泄性尿路造影检查(MCU)及其分级,并随访其预后。结果本研究共纳入VUR患儿41例,其中≤1岁31例(75.6%),男27例,女14例。MCU分级轻度反流组(Ⅰ、Ⅱ级)9例,中度反流组(Ⅲ级)16例,重度反流组(Ⅳ、Ⅴ)16例。3组间性别、年龄、反流状况(单侧/双侧)、≥2次泌尿道感染率、合并其他结构异常比较,差异无统计学意义(P0.05)。确诊6个月至3年后进行MCU复查,MCU反流完全缓解12例,部分缓解9例,无改变15例,加重5例。随着反流级别升高,缓解率呈下降趋势(P=0.008)。24例在预防剂量中或停药后出现感染复发。随着反流级别升高,感染复发率呈上升趋势(P=0.014)。结论婴儿泌尿道感染易发生VUR。反流程度与预后关系密切,应根据反流程度采取相应的诊治措施。  相似文献   

11.
首诊泌尿道感染患儿影像学检查评价与分析   总被引:1,自引:0,他引:1  
目的通过对首次就诊的UTI患儿核素肾皮质显像、肾脏B超等影像检查结果进行分析比较,从而探讨小儿UTI影像学检查的策略。方法研究对象为224例首次就诊的UTI患儿,在1周内进行99Tcm-DMSA肾皮质显像及肾脏超声检查评价是否有肾实质感染,一到两周内进行膀胱输尿管显像以评价VUR。结果经DMSA显像证实121例(54%)存在肾实质感染,其中8人伴肾瘢痕形成;103例(46%)DMSA显像正常。以DMSA肾显像为诊断标准,B超检查评价肾实质感染的灵敏度为53.72%。在肾实质感染患儿中,41%存在膀胱输尿管返流。100个发生损害的肾脏,48%存在膀胱输尿管返流;而92个未发生损害的肾脏,有1个存在中度VUR。在有肾瘢痕的UTI患儿中,75%存在膀胱输尿管返流。对VUR分度及肾损害分级进行等级相关分析,发现肾损害分级程度越重,VUR分度越高。结论对首诊的UTI患儿,临床上怀疑肾实质感染者,应行DMSA显像以准确评价肾损害程度,B超检查可作为筛查及补充手段;DMSA显像提示肾损害或有反复尿路感染者,尤其是有瘢痕形成的UTI患儿,行VUR检测十分必要,并建议3~6个月后随访DMSA显像,以检测是否发生肾瘢痕。  相似文献   

12.
A retrospective trial was performed to study presentation, evaluation, management, complications and outcome of 186 infants with vesicoureteral reflux (VUR). Medical records of 103 male and 83 female infants with mean age at entry 5.97 months were reviewed. Diagnosis was established using radiographic voiding cystourethrogram. At diagnosis, a renal ultrasound and dimercaptosuccinic acid renal scintigraphy were performed in all children. The follow-up included blood pressure measurements, serial urine cultures, haematological and biochemical tests, radionuclide cystography, renal ultrasounds and renal scintigraphy. The majority of infants with reflux, 176/186, presented with one or more episodes of urinary tract infections. In 113 children, reflux resolved spontaneously, 27 underwent surgical or endoscopic correction and 46 are being followed-up to date. Spontaneous resolution after prophylaxis was more frequent in boys (p < 0.0001), in children with grade I or II (p < 0.0001) and unilateral reflux at diagnosis (p = 0.0215). No significant difference could be established with respect to the presence of scars (p = 0.1680) and the number of breakthrough urinary tract infections (p = 0.1078). The data of the present study indicate that spontaneous resolution rate is high in infants, and therefore, early antireflux  相似文献   

13.
IntroductionRenal abscesses are rare in pediatric populations. We aimed to highlight the differences in the computed tomography (CT) imaging characteristics of renal abscesses in patients with and without vesicoureteral reflux (VUR).Materials and methodsThirteen children with renal abscesses were included and categorized into those with and without VUR. Blood and urine culture results were recorded as positive or negative. Imaging characteristics were recorded: with/without subcapsular fluid collection, with/without upper/lower pole involvement, and with single/multiple lesions in kidneys. Fisher's exact test was used for intergroup comparisons of the rate of positive pathogens and imaging characteristics.ResultsNine patients had VUR (45.9%). Blood and urine culture were positive in two (15.4%) and seven cases (53.8%), respectively. There was no significant difference in the rate of pathogen-positive blood and urine cultures (blood culture positive/negative status with VUR vs. that without VUR = 2/7 vs. 0/4, p > 0.999, urine culture positive/negative status with VUR vs. that without VUR = 4/5 vs. 3/1, p = 0.559). The two groups differed significantly regarding subcapsular fluid collection presence (with/without subcapsular fluid collection with VUR vs. that without VUR = 9/0 vs 1/3, p = 0.014). There was no significant difference in upper/lower pole involvement (with/without involving upper/lower pole with VUR vs. that without VUR = 8/1 vs 2/2, p = 0.203). Patients with VUR were non-significantly more likely to have multiple lesions compared to those without VUR.ConclusionsVUR was associated with subcapsular fluid collection and possibly with multiple lesions, indicating the need for prompt detection of and specific treatment for VUR in cases with these findings.  相似文献   

14.
PURPOSE: The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). METHODS: In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by kappa statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test. RESULTS: The agreement between CE-VUS and VCUG in predicting VUR was 90% (kappa score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (kappa score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar chi2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used. CONCLUSIONS: The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR.  相似文献   

15.
The postnatal persistence of fetal hydronephrosis requires further evaluation to establish whether pathological abnormalities are present. This study determined the necessity for voiding cystourethrography (VCUG) to identify vesicoureteral reflux (VUR) in children (n = 195) with prenatally diagnosed hydronephrosis. Among the study population, the prevalence of VUR was 17.4% (24 males, 10 females). There was a poor correlation between the severity of hydronephrosis, ureteral dilatation, presence of bilateral hydronephrosis and presence of VUR. Except for the frequency of urinary tract infections and the presence of renal damage on (99m)Tc-dimercaptosuccinic acid scans, VCUG was the only reliable method for confirming VUR in this study. The diagnosis of VUR is important for the early detection of renal damage. Further information is needed to develop the optimal approach to the evaluation of prenatal hydronephrosis, with reliable parameters that avoid invasive procedures such as VCUG.  相似文献   

16.
Background Many studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy is the most sensitive diagnostic method in the identification of irreversible renal lesions (scars) in children with previous episodes of acute pyelonephritis (APN). This study assessed the reliability of ultrasound in identifying reflux nephropathy in children with acute pyelonephritis with or without vesicoureteric reflux (VUR). Methods Eighty children (45 female and 35 male, age range 5 months to 10 years, average age 2 years 1 month) with a positive history for at least one episode of APN participated in this study. All children underwent voiding cystourethrography, DMSA scintigraphy 4 to 8 months after the most recent episode of APN, and an ultrasound test evaluation less than 2 months after DMSA scintigraphy. Results Voiding cystourethrograms showed VUR in 52 children (68%); 13 of these were bilateral, for a total of 65 refluxing kidney units of the 154 (42%) evaluated; DMSA scintigram was normal for 108 of 154 kidneys (70%). Of the 65 kidneys with VUR, DMSA scintigram displayed normal findings in 29 cases (45%) and pathologic findings in 36 (55%). In the 79 nonrefluxing kidneys, DMSA scintigram was normal in 69 cases (87%). The relative risk of scarring in VUR kidneys is 2.6. The ultrasound study recorded a maximum longitudinal diameter between the 5th and 95th percentiles in 80 of 89 (81%) kidneys without VUR and in 21 of 65 (32%) with VUR. A significant correlation was found between maximum longitudinal diameters and DMSA scintigraphic findings in kidneys with VUR and those without VUR, respectively. Conclusion This study establishes that ultrasound scans, by means of a simple and reproducible measurement technique, maximum longitudinal diameter, have a predictive value with regard to the presence of scars, with few exceptions. This finding, in our opinion, could lead to a decrease in the number of invasive procedures, in particular DMSA scan, in patients with APN.  相似文献   

17.
Among issues susceptible to hamper a reliable measurement of inulin clearance, those regarding the dosage of inulin are largely neglected. We have compared the analytical performances of 2 commonly used methods of inulin dosage (one "acid" and one "enzymatic" method) and studied their potential impact on the glomerular filtration rate (GFR) value given by inulin clearance. Repeatability, uncertainty and the beta-expectation limits were evaluated from pre-determined serum and urine pools of inulin. Agreement between the two methods was analyzed from 99 inulin clearances performed in renal transplant patients. Impact of the method of dosage on GFR evaluation was simulated according to the respective beta-expectations limits of each method. Overall, intra-assay coefficient of variability and relative bias were inferior to 5% and 10% for both methods. Contrary to the acid method, analytical performance of the enzymatic method was not influenced by the presence of glucose. The relative difference in GFR values obtained with the two methods in transplant patients was -0.4 ± 10%. Simulations suggested that changes in inulin concentration attributable to analytical error could modify the value of GFR from -12% to +28%. In conclusion, while analytical performances are globally acceptable for both methods, they are not strictly equivalent. The impact on the determination of GFR, albeit limited, is not negligible and adds to other sources of inaccuracy. International standardization for the dosage of inulin is necessary.  相似文献   

18.
Comparative viewing modalities for CT cystography   总被引:5,自引:0,他引:5  
Background: To define the speed and accuracy of two different reconstructive techniques using computed tomography (CT) cystography for the detection and measurement of urinary bladder masses and determine the overall ease of use. Methods: Ten patients scheduled for cystoscopy for the evaluation of hematuria or bladder masses were studied by means of thin-section CT of the air-distended bladder. Two techniques were employed by two radiologists to blindly interpret the data: conventional two-dimensional data with interactive three-dimensional problem solving (2D3DPS) and surface-shaded display (SSD) three-dimensional images. The results were compared with the data from cystoscopy. Results: Twenty-two (100%) of 22 masses detected on cystoscopy were visualized using the reconstructive techniques. Both modalities were shown to have high accuracy, but only the 2D3DPS had a sensitivity and specificity of 100% for both observers at the patient-level diagnosis. The sensitivities for detecting individual masses for the two observers were 100% and 64% for 2D3DPS and 64% and 70% for SSD. Conclusion: Both methods used to display the CT data had a high sensitivity and specificity for masses, but only the 2D3DPS had a sensitivity and specificity of 100% at the patient-level diagnosis, thus making it a feasible imaging modality for cystography. It was also preferred overall for ease of use, high accuracy, and relative low cost. Received: 22 March 2000/Accepted: 3 May 2000  相似文献   

19.
目的:探讨放射性核素99mTc-DTPA肾动态显像对IVP不显影患肾功能评价的临床意义。方法:对37例受检者(40只患肾)进行了肾动态显像,并与同期IVP检查对比分析。结果:37例受检者中核素显像显示有功能者91.2%,无功能者9.8%;IVP检查显示有功能者38.7%,无功能者61.3%。可见,核素显像显示有功能者明显高于IVP检查(P〈0.01)。IVP不显影的患肾99mTc-DTPA动态显像主要表现为Ⅱ-Ⅲ级,即放射性摄取中度以上减少占81.5%GFR均值22.8 mL/min,肾实质不显影占18.5%。结论:99mTc-DTPA肾动态显像较IVP不显影患肾功能的评价可以获得直观的肾脏摄取-排泄曲线和GFR值,从而能够定量的评判分肾功能,为术式的选择提供重要依据。此法简便、无创、灵敏及可重复性的特点,是评价肾功能的理想方法。  相似文献   

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