彩色多普勒观察膀胱喷尿现象在判断输尿管结石梗阻中的作用

本文利用彩色多普勒观察输尿管结石梗阻患者和正常人膀胱喷尿情况,以探讨彩色多普勒在判断膀胱输尿管结石梗阻中的作用。因尿液由输尿管入膀胱呈喷射状,有一定速度,彩色多普勒可以较清晰地观察尿液流动信号(以下简称尿流信号),在分析输尿管结石中有一定价值。 资料和方法 本文病例组38例,其中第一狭窄结石11例,第二狭窄结石5例,第三狭窄结石22例。男28例,女10例,年龄29～63岁,平均42.5岁。结石大小在0.4～2.2cm。对照组选择正常人30例,男26例,女22例,年龄27～61岁,平均44.5岁。病例组及对照组所有受试者肾功能均正常。     

腔内超声诊断盆段输尿管结石的价值

目的 探讨经阴道或直肠彩色多普勒超声对输尿管盆段结石诊断的价值.方法 用腔内彩色多普勒超声检查10例正常人双侧输尿管和21例输尿管盆段结石者的正常与患侧输尿管,显示输尿管及腔内结石;测量排尿期及排尿间隔期输尿管腔内径,记录输尿管口喷尿持续时间、间歇时间.结果 腔内超声对输尿管盆段结石的显示率100%.结石近段管腔内径较...     

彩色多普勒超声观测闭合性肾损伤时输尿管喷尿的改变

目的 应用彩色多普勒超声,通过对闭合性肾损伤者输尿管喷尿情况的观测,判定有无肾功能损伤及损伤程度.方法 选择单侧闭合性肾损伤患者31例,应用彩色多普勒超声分别观测正常侧与损伤侧输尿管膀胱开口处的彩色尿流形态、喷尿频率、尿流速度、喷尿持续时间.结果 正常侧彩色多普勒尿流呈鲜红色,每分钟喷尿4～8次,每次持续时间5.8～8.6 s,尿流峰值速度23～48 cm/s.损伤侧尿流射程明显变短,色彩暗淡,严重者可无彩色尿流显示,每分钟喷尿0～3次,每次持续时间0～4.6 s,尿流峰值速度0～18 cm/s.且各项指标降低程度与损伤程度成正比.结论 输尿管喷尿与肾功能密切相关.对闭合性肾损伤患者,通过观测输尿管喷尿情况,可判定肾功能有无损伤及损伤程度.     

彩色多普勒在输尿管结石中的应用

本文报道应用彩色多普勒观察输尿管开口喷尿４６例，其中正常受试者２４例，输尿管结石２２例。正常受试者的双侧输尿管开口喷尿形态、频率和喷射方向对称。在输尿管结石病人中，有１７例输尿管的开口喷尿异常，特点是喷尿消失、喷尿形态改变和频率减少，与正常组比较，相差极显著（Ｐ＜０．０１）。彩色多普勒观察输尿管开口喷尿优于二维超声和双功多普勒，它是判定输尿管梗阻性疾病的重要筛选工具。     

彩超对输尿管梗阻的诊断价值

应用超声显像诊断输尿管梗阻已被广大临床医师所接受,尤其是对于结石、肿瘤等引起的肾积水、输尿管扩张的病 例,较易明确诊断。本文现就18例有腰腹疼痛及尿道刺激症状,而黑白B超检查未发现明显梗阻征象,通过彩超观察输尿管喷尿改变而逆向检查观察出梗阻部位,及X线静脉造影对照分析报告如下。 18例中14例为男性,4例为女性。年龄在7～52岁,均为单侧输尿管梗阻,右侧13例,左侧5例,应用百胜ALL 4100彩超诊断仪,探头频率3.5～5.0MHz。检查前,患者饮水500～800毫升,待膀胱充盈后开始检查,先取左侧卧位或右侧卧位,观察肾内情况,然后沿输尿管声引方向探查,最后取仰卧位探查膀胱,利用CDFI,观察输尿管喷尿情况,全部患者均拟行X线静脉尿路造影,对照观察。     

“彩色彗尾征”——输尿管结石的彩色多普勒超声特征

目的 :探讨彩色多普勒超声在输尿管结石中的特征性表现和应用价值。方法 :对 80例输尿管结石进行了彩色多普勒超声检查 ,并与 B超进行了对比分析。结果 :80例经彩色多普勒超声诊断的输尿管结石 ,上中下段结石的特征为可见结石后方的五彩尿流信号——“彩色彗尾征”,阳性率 97.5 % ,特异性 10 0 % ,而下段结石还具有输尿管喷尿受阻的特征而出现喷尿消失 ,两侧对比鲜明 ,经排石和手术得以证实。结论 :“彩色彗尾征”是彩色多普勒超声诊断输尿管结石的特异性征象 ,有确诊价值 ,输尿管喷尿两侧不对称可作为可疑输尿管结石的指标 ,弥补了B超诊断的不足。对有明显结石症状而高度怀疑泌尿系结石的患者 ,在 B超检查结果阴性时建议加做彩超检查 ,以免漏诊、误诊。     

彩色多普勒超声诊断输尿管结石的临床价值

目的：探讨彩色多普勒（CDFI）超声对输尿管结石的诊断价值。方法：回顾160例输尿管结石病例,经CDFI检测输尿管结石周边尿流变化及输尿管开口喷尿情况的变化,确定结石的存在。结果：上段结石78例,中段20例,下段62例,结石周边尿流出现五彩镶嵌彩色信号,且输尿管开口喷尿出现异常。结论：CDFI对输尿管结石诊断率高,重复性好,无痛 苦,可作为输尿管结石的首选检查方法。     

口服钆喷酸葡胺稀释液联合容积扫描磁共振尿路成像在输尿管梗阻性疾病中的应用

目的 探讨口服钆喷酸葡胺稀释液联合容积扫描磁共振尿路成像（MRU）技术对输尿管病变的诊断价值.方法 对20例经B超、静脉肾盂造影（IVP）检查初步发现尿路扩张或梗阻的患者行口服钆喷酸葡胺稀释液联合容积扫描MRU检查.结果 20例患者经MRU检查均能清晰地显示输尿管梗阻的部位及梗阻以上部位的扩张程度,并且未见胃肠道伪影干扰.其中单侧梗阻18例,双侧梗阻2例;肾盂输尿管交界处梗阻2例,输尿管上段梗阻10例,输尿管中下段梗阻7例,输尿管膀胱连接部梗阻1例.对梗阻部位及周围结构进行MRI扫描示：单侧输尿管结石11例,双侧输尿管结石2例,MRU表现为梗阻端充盈缺损,结石部位呈低信号;输尿管肿瘤4例,肿瘤以上输尿管呈不同程度扩张,肿瘤软组织影呈不均匀信号;肾盂输尿管交界处狭窄2例,MRU表现为病变处的输尿管变细,其以上无明显的充盈缺损,肾盂显著扩张呈囊状,肾盂结构消失,输尿管以下未见明显扩张征象;输尿管末端闭锁1例,MRU表现为输尿管迂曲扩张向中线移位呈“S”形改变,其末端相对狭窄呈细线样征,其内末见占位性病变.结论 口服钆喷酸葡胺稀释液联合容积扫描MRU技术是诊断输尿管梗阻性疾病的重要手段,其无创伤、无辐射,不需要造影剂,能明显及清晰地显示病灶位置及性质,可作为输尿管梗阻性病变的诊断及检查的首选方法,具有较高的临床诊断和应用价值.     

输尿管囊肿的三维超声和彩色多普勒诊断

目的 :评估三维超声、彩色多普勒超声对输尿管囊肿的应用价值。方法 :用三维、彩色多普勒血流观察了 10例输尿管囊肿的立体形态及喷尿情况。结果 :三维超声立体感强 ,形态逼真 ,定位准确。彩色多普勒显像示喷尿的尿流束由囊肿内向膀胱喷射时较为明显 ,表现为细而色艳的彩色流束 ,而由输尿管向囊肿内喷射时流束则呈粗而色暗。结论 :三维超声和彩色多普勒超声能提高诊断输尿管囊肿的准确率 ,为临床提供更准确的诊疗信息     

输尿管梗阻性疾病腔内诊疗研究

目的探讨腔内镜对输尿管梗阻性疾病的诊疗价值。方法对2002年1月～2005年1月期间收治46例输尿管息肉、肿瘤、狭窄及囊肿等梗阻性疾病通过腔内镜检查明确诊断,部分病例需要内镜下活组织检查,经病理确诊;采用不同腔内镜,或其中两镜联用进行治疗。结果46例输尿管梗阻中输尿管息肉11例;输尿管肿瘤9例;输尿管囊肿5例;输尿管狭窄21例。所有病例均行腔内镜治疗（3例依靠腔内镜明确诊断同期给予治疗）。治疗成功率为94.3%,无输尿管穿孔等并发症。结论腔内镜有助于明确输尿管占位良恶性,并对早期输尿管肿瘤确定诊断;多数输尿管梗阻性疾病可以同期完成诊断和治疗,缩短诊疗周期;微创、高效使治疗可重复进行。     

腹腔镜治疗管外压迫致输尿管梗阻40例

目的 探讨腹腔镜下输尿管松解和／或吻合术治疗管外压迫致输尿管梗阻性疾病的效果。方法 该组40例，平均48．6岁；单侧32例，双侧8例。B超检查均有患侧肾输尿管扩张、积水，其中轻、中、重度肾积水分别为5、23和12例。手术经腹腔路径24例，腹膜后途径16例，于腹腔镜下予松解和／或切除病变段后行输尿管-输尿管或输尿管-膀胱吻合术治疗。结果 40例手术均获成功，平均手术时间110．5min（75～175min），平均术中出血125．5mL（80～250mL），均无输血，术后3d起均无明显漏尿。平均随访16个月（3-72个月）。30例行IVU、B超复查患肾分泌恢复正常；10例肾积水明显减轻，肾功能改善；吻合口无狭窄。结论 有熟练操作经验的腹腔镜下松解和／或吻合术治疗管外压迫致输尿管梗阻性疾病，初步随访效果良好，有微创优势和实用价值。     

Ureteric jet in renal transplantation patient

We have made a case for an active sphincteric mechanism at the VUJ modifying the ureteric jet Doppler waveform. The transplanted ureter does not have a normal VUJ, but retains inherent peristalsis. This study was to document any difference in the transplanted ureteric jet Doppler pattern. A total of 55 transplant patients and 817 healthy subjects were recruited. The Doppler waveform of the transplanted ureter is distinctly different from that of the healthy adult ureter. There are two major patterns: a short monophasic waveform is the most common (66.1% vs. 2.6% in healthy ureters). Less common is a longer, more phasic, pattern, which, however, does not resemble the patterns of the healthy ureter. This supports the hypothesis that the mode of action at the VUJ is sphincteric, because this is lost with transplantation, and ureteric drainage reverts to a simple unmodified pattern.     

重复肾重复输尿管畸形的超声诊断

目的探讨重复肾重复输尿管畸形的超声图像特点。方法对15例经手术及临床证实的重复肾重复输尿管畸形患者的超声表现进行回顾性分析。结果重复肾声像图表现可分为3类：①肾窦被一形似柱状低回声结构分为上下相互独立的两部分,其余形态与正常肾脏无明显差异。②上或（和）下位肾因引流不畅导致相应肾脏积水。③上位肾重度积水,呈一个球形无回声区。重复输尿管声像图表现亦分为3类：①不完全性双输尿管。上下肾的输尿管呈Y型融合为一根输尿管,并开口于膀胱内正常位置。②完全性双输尿管。二根输尿管完全分开,分别引流上下肾的尿液,并同时开口于膀胱三角区,一般下肾的输尿管开口于膀胱内的正常位置。③完全性双输尿管伴上肾输尿管异位开口。即完全性双输尿管中下肾输尿管开口于膀胱内,而上肾输尿管开口于膀胱以外部位。结论超声对重复肾重复输尿管的完整诊断以及鉴别诊断方面有很大价值。     

Surgical treatment of reflux in completely duplicated ureters.

Vesicoureteral reflux occurs in approximately 50% of duplex systems that undergo evaluation and most commonly involves the lower renal segment ureter. The therapeutic approach can be tailored for each case after careful evaluation of the anatomic and functional status of each renal unit. If reparative srugery is indicated and only one ureter is involved, then ureteropyelostomy or ureteroureterostomy have yielded excellent results. If more than one ureter is involved with either relfux or obstruction, then reimplantation of the paired ureters is indicated if the renal units are slavageable.     

输尿管镜置取双J管的体会

目的：引流尿液防止和减少外渗，避免粘连，暂时缓解梗阻，降低肾内压，保护肾功能，减轻感染，防止粘连和狭窄。方法：经输尿管镜或膀胱镜置入。结果：用输尿管镜，膀胱镜置取管1960例。结果：全部患者取管1月后静脉肾盂造影输尿管通畅。结论：上尿路术后置入双J管对防止输尿管术后并发症的发生有不可替代的作用。当导管缩回输尿管腔或术中置管未达膀胱时首选用输尿管镜取管。     

Magnetic resonance velocity mapping of normal transtricuspid velocity profiles

To investigate the velocity profiles of transtricuspid inflow, we examined 20 normal subjects (17 males and 3 females, mean age 27 ± 7) by the magnetic resonance imaging (MRI). Electrocardiographic gating was performed in all anatomical and flow studies, and sequences were triggered by the R wave. Cine gradient echo images (echo time, 14 ms) were acquired in the right ventricular horizontal long axis, and from these, cine images with velocity mapping were obtained in the short axis of the right ventricle. Velocity mapping of right ventricular inflow was obtained at peak early diastolic filling. Velocity profile curves across the tricuspid inflow were obtained at each 1 cm interval from the tricuspid ring to 3 cm into the cavity. Maximum/mean velocity was 1.1 ± 0.1 at ring level, unchanged at 1 cm from the tricuspid ring, and thereafter increased to 1.4 ± 0.3 at 2 cm, and 1.5 ± 0.3 at 3 cm as peak velocity fell. The ratio of the longest and shortest jet width cross section was 1.3 ± 0.3 at ring level, and increased to 1.5 ± 0.3 at 3 cm from ring level. Jet cross sectional area was 10.4 ± 2.1 cm² at ring level, and was unchanged at 3 cm level. Thus, tricuspid inflow velocity showed a relatively flat profile at the tricuspid ring and tip level, becoming more dispersed at 2 and 3 cm from the ring. Right ventricular inflow jet cross section was elliptic, and appeared to be relatively constant in the cross- sectional area.     

双侧输尿管逆行插管在开腹子宫切除术中的作用

目的:探讨双侧输尿管逆行插管在经腹子宫切除术中的作用。方法:麻醉后患者采用膀胱截石位或人字位,用宫腔治疗镜或膀胱镜进行双侧输尿管逆行插管。结果:困难复杂的手术98例,无一例发生输尿管损伤。结论:双侧输尿管逆行插管在困难子宫切除术中可明确输尿管的位置,避免输尿管损伤的发生。     

Application of ultrasonic shift Doppler technique to record velocity changes of intrauretral urine flow.

Velocity Changes of intraluminal urine flow were recorded using the ultrasonic shift Doppler principle on exposed ureters of five adult mongrel dogs. This method has been used for further understanding of the speed of urine transport within the ureter when it is affected by ureteral peristalsis and the level of diuresis. Simultaneous recording of urine velocity curves and electroureterograms were performed. The results indicate that there is a direct relationship between intraluminal urine flow and peristaltic contraction. The results also show that the velocity of a urine bolus is highest during olguric conditions (urine flow1 ml/min), and, at polyuric conditions (urine flow 3 ml/min) the flow through the ureter is continuous.     

Reduced early diastolic inflow velocities in the antero-posterior transverse direction in the left ventricle of patients with dilated cardiomyopathy

In patients with dilated cardiomyopathy (DCM), the left ventricular (LV) inflow jet is narrow and has a high pressure gradient. A pulsed Doppler restrictive transmitral flow pattern is a characteristic feature of severe left ventricular disease. However, Doppler flow analysis is limited by the angle between the blood flow jet and the ultrasonic beam. In this study we used gated magnetic resonance imaging (MRI) to investigate the inflow velocity in the LV transverse directions during early diastole in patients with DCM. Methods: We studied 10 patients with DCM (mean age: 47 y). Ten age-matched healthy volunteers were also examined. Gradient echo images of the LV were obtained. Left ventricular short axis phase contrast images were obtained at the level of the mitral valve tip and 1 cm inside the LV. Long axis images were also obtained. Through-plane peak velocities at peak early diastolic filling were measured along the LV long axis, antero-posterior short axis, and right-left short axis. Blood velocity was measured in 50 ms blocks. Results: Early diastolic inflow velocity along the long axis, especially at the center of the LV, was well preserved in DCM. However, the inflow velocity in the antero-posterior transverse direction of the LV (i.e., in the direction of mitral valve excursion) was significantly reduced in DCM. Conclusions: Early diastolic inflow velocity in the antero-posterior transverse direction of the LV is reduced in patients with DCM indicating that the vector component of the forces acting in the antero-posterior transverse direction of the LV may be decreased in patients with DCM during early diastolic filling.