三种检查方式对输尿管结石所致急性肾绞痛诊断价值的比较

目的 比较超声、泌尿系平片(KUB)和螺旋CT平扫对输尿管结石所致急性肾绞痛诊断的价值,为临床诊断提供一种高效、无创的检查方法.方法 选取2011年1月至2013年8月在昆明医科大学第二附属医院泌尿外科确诊为输尿管结石的患者194例,其中9例为双侧输尿管结石,共203侧.所有患者均行超声、KUB和螺旋CT平扫检查,将3种检查结果与金标准进行对比研究.结果 于多层螺旋CT平扫诊断符合率100％,KUB诊断符合率为79.31％,超声检查诊断符合率为73.40％.螺旋CT平扫诊断符合率明显高于KUB及超声,统计学分析,差异有统计学意义(P＜0.01).KUB及超声对输尿管结石的诊断符合率统计学分析差异无统计学意义(P＞0.05).结论 非增强螺旋CT平扫对输尿管结石所致急性肾绞痛的诊断价值优于超声和KUB,是一种高效、准确的检查方法.     

Bedside Emergency Department Ultrasonography plus Radiography of the Kidneys, Ureters, and Bladder vs Intravenous Pyelography in the Evaluation of Suspected Ureteral Colic

Abstract. Objective : To determine the role of bedside renal ultrasonography (US) and plain radiography of the kidneys, ureters, and bladder (KUB) as the initial investigative modality for those patients presenting to the ED with unilateral flank pain and he-maturia. The hypothesis was that the renal US + KUB may obviate the need for emergent IV pyelography (IVP) in a majority of patients. Methods : Prospective study over an 8-month period of all consecutive adult patients between the ages of 18 and 65 years presenting with unilateral flank pain and he-maturia to the ED at LAC + USC Medical Center. Patients received KUB followed by a 500-mL bolus of normal saline. Bedside US was then performed by emergency physicians (EPs). Hydronephrosis of the kidney was graded as mild, moderate, or severe. All patients then underwent IVP. The results of the bedside US + KUB were then compared with those of IVP (the criterion standard). Results : Of a total of 139 eligible patients, 108 were enrolled. The combination of US and KUB correctly identified pathology consistent with nephroureterolithiasis with a sensitivity of 97.1% (95% CI = 93.1–100%) when compared with IVP. The KUB + US results were falsely positive in 16 patients, resulting in a specificity of 58.9% (95% CI = 43.5–74.3%). The positive predictive value of the combined modality was 80.7%, the negative predictive value was 92.0%, and the overall accuracy was 83.3%. Conclusion : The bedside US + KUB has a high sensitivity and can be performed rapidly at the bedside by the EP when compared with IVP. This combined modality is an effective screening tool in the initial evaluation of ureteral colic.     

多排螺旋CT非增强对泌尿系结石的诊断价值

目的探讨多排螺旋CT非增强对泌尿系结石的诊断价值。方法回顾性分析70例临床怀疑泌尿系结石的患者资料,均已做多排螺旋CT平扫、B超、KUB及IVU检查（CT扫描所得原始数据传至AW4．3工作站进行图像重建）。结果58例确诊为泌尿系结石（其中1例自行排出,4例保守治疗后自行排出,36例体外碎石后排出,10例输尿管镜取出,7例经皮肾取出）患者,多排螺旋CT非增强诊断泌尿系结石58例;B超诊断泌尿系结石44例,2例假阳性;KUB诊断泌尿系结石38例,4例假阳性;IVU诊断泌尿系结石42例,3例假阳性;多排螺旋CT非增强、B超、KUB、IVU敏感度分别为100％、76％、66％、72％,特异度分别为100％、83％、67％、75％,阳性预测值分别为100％、96％、90％、93％,阴性预测值分别为100％、42％、29％、36％,约登指数分别为1．0、0．59、0．32、0．47。多排螺旋CT非增强与B超、KUB、IVU比较,Х^2值分别为15．92、24．17、19．92,P值均小于0．01,差异均有统计学意义。结论多排螺旋CT非增强的敏感度、特异度均比B超、KUB、IVU高,是诊断泌尿系结石的最有效方法。     

小儿下尿路结石的诊治分析

目的　探讨小儿下尿路结石不同影像学检查的价值及其对治疗结果的影响。方法　回顾性分析2014年1月至2017年8月在伽师县人民医院和喀什地区第一人民医院就诊的105例下尿路结石患儿的临床资料。105例患儿按照是否做非增强螺旋计算机断层扫描（NCCT）进行分组，A组行超声（US）+尿路平片（KUB）检查，B组行US + KUB + NCCT检查，两组患儿均行经尿道膀胱结石碎石术。A组50例，均为男性患儿，年龄（2.09±1.37）岁；B组55例，其中男54例、女1例，年龄（2.61±1.56）岁。比较两组患儿的结石检出率和围术期指标。统计学方法采用独立样本t检验和χ²检验。结果　105例患儿均确诊为下尿路结石；100例患儿做US检查，检出率为98.00%（98/100）；99例做KUB检查，检出率为74.75%（74/99）；55例做NCCT检查，检出率为98.18%（54/55）。其中A组患儿US+KUB合并检出率为100.00%（50/50）；B组患儿US+KUB+NCCT合并检出率为100.00%（55/55）。NCCT检查发现了1例US + KUB均未发现的尿道结石，1例发现左肾结石（均未改变手术方案）。手术均成功，术后均无严重并发症。两组患儿的术后留置尿管时间（P=0.363）、住院时间（P=0.077）及并发症发生率（P=0.627）比较差异均无统计学意义。B组手术时间比A组短［（19.63±11.82）min比（28.20±13.49）min］，两组比较差异有统计学意义（t=3.469，P<0.001）。结论　临床疑为小儿下尿路结石时，均应以US和/或KUB作为初查方法，足够诊断和制定治疗方案，还可以避免CT检查带来的辐射和经济压力。此方案值得在我国新疆南部的喀什等贫困地区进一步推广和使用。     

静脉肾盂造影加腹部平片检查前5种肠道准备方法的临床研究

目的寻找一种简单实用的清洁肠道方法,以保证静脉肾盂造影 腹部平片(IVP KUB)的检查效果.方法自然选取行IVP KUB检查的535例患者,按入院时间分为A、B、C、D、E5组,分别采取5种肠道准备方法,观察影片效果,患者不良反应,排便情况.结果 A、B、C、D组与E组比较,差异显著(P值均＜0.01),E组不良反应发生率仅为4.5%,排便次数合格率为90.9%.结论 20%甘露醇250ml NS250ml于检查前顿服,影片效果好,患者不良反应小,排便次数适中,具有临床应用及推广价值.     

Comparison of dimercaptosuccinic acid and calcium disodium ethylenediaminetetraacetic acid versus dimercaptopropanol and ethylenediaminetetraacetic acid in children with lead poisoning

Objectives: To compare the response to dimercaptopropanol (BAL) and calcium disodium ethylenediaminetetraacetic acid (EDTA) versus orally administered meso-2,3-dimercaptosuccinic acid (DMSA) and EDTA in children with lead poisoning.Methods: Retrospective review of medical records of children admitted to MetroHealth Medical Center with a whole blood lead (BPb) concentration of 2.17 μmol/L (45 μg/dl) or more (or less than 2.17 μmol/L and not a candidate for outpatient oral chelation) and treated with BAL + EDTA or DMSA + EDTA. In each group, the mean BPb values at the end of therapy and at 14 and 33 days after chelation were compared with pretreatment BPb by the Wilcoxon signed-rank test, whereas the Mann-Whitney U test was used to compare percentage change from pretreatment at each follow-up day between the two groups.Results: Twenty-three children received BAL + EDTA and 22 received DMSA + EDTA.The BPb values (mean ± SD) at the end of therapy and at 14 and 33 days after chelation were significantly lower than pretreatment in both groups (BAL + EDTA: 17 ± 10, 34 ± 7, 36 ± 11 vs 58 ± 14 μg/dl, p <0.02, 0.01, 0.001, respectively; DMSA + EDTA: 10 ± 4, 30 ± 10, 30 ± 14 vs 50 ± 10 μg/dl, p <0.01, 0.001, 0.01, respectively). The percentage reduction (mean ± SD) in BPb from pretreatment at the end of therapy and on days 14 and 33 after chelation did not differ between the groups (BAL + EDTA: −71.2% ± 19.8%, −40.2% ± 13.8%, −37.1% ± 17%; DMSA + EDTA: −79.9% ± 8.7%, −38.3% ± 21.6%, −37% ± 32%; p >0.20). Elevation of alanine aminotransferase and vomiting during therapy were observed more frequently in the BAL + EDTA group compared with the DMSA + EDTA group.Conclusions: Treatment with DMSA or BAL combined with EDTA results in a comparable reduction in BPb. (J Ppediatr 1997;130:966-71)     

增强CT后即刻或延迟摄取泌尿系平片在膀胱癌患者中的临床应用价值

目的探讨增强CT后即刻或延迟摄取泌尿系平片（CT后KUB）在膀胱癌患者中的临床应用价值。方法对60例膀胱癌患者均行CT后KUB检查及静脉尿路造影（IVU）检查。结果 60例患者中,CT后KUB获得良好上尿路成像效果55例,成像效果不佳5例;IVU仅1例未获得良好上尿路成像效果,两者之间无统计学差异（P〉0.05）。结论对于浸润性膀胱癌患者,增强CT后即刻或延迟摄取泌尿系平片检查可以获得良好的上尿路成像效果,有望取代IVU检查。     

输尿管阴性结石的非增强螺旋CT影像分析

目的应用非增强螺旋CT(NCHCT)分析输尿管阴性结石的CT特征。方法回顾性分析54例输尿管阴性结石(阴性结石组)的住院资料和NCHCT图像,并与同期47例腹部尿路平片(KUB)阳性输尿管结石(阳性结石组)的CT结果进行比较。结果 54例输尿管阴性结石在NCHCT上均能清晰显示。输尿管上段、中段和下段的阴性结石均显著比阳性结石小(P<0.05或P<0.01)。两组上、中段结石CT值差异不显著,阴性结石组下段结石显著小于阳性结石组(P<0.05)。结论输尿管阴性结石普遍较阳性结石小;NCHCT是输尿管阴性结石的确诊手段之一。