输尿管非结石性梗阻肾积水影像特征分析

目的　分析输尿管非结石梗阻性肾积水的影像特征 ,提高对其的识别能力。方法　根据静脉肾盂造影、逆行尿路造影结果 ,对自 1997-0 1～ 2 0 0 4-0 2经手术和病理证实的输尿管非结石性梗阻肾积水 5 7例的影像及病理资料进行对照分析。结果　中、重度肾积水 47例 ,占 82 .5 % ,其中重度肾积水 2 3例中 ,输尿管肾盂高位连接 12例 ,低位连接 8例 ,输尿管局限狭窄的发病率为85 .1% ,其中输尿管多发和 /或双侧输尿管狭窄的发病率为 2 2 .0 % ,其它原因所致输尿管狭窄的发生率为 14 .9%。结论　输尿管非结石性梗阻的病因具有多样性 ,肾积水的不同影像改变与输尿管病变位置不同密切相关。当一侧肾为重度积水 ,另一侧肾盂表现为“壶腹”型肾盂时应注意排除双侧输尿管存在病变的可能性     

先天性巨输尿管症的X线诊断：附26例报告

目的：提高对先天性巨输尿管症的认识和诊断。材料和方法：作者总结分析了２６例均经膀胱镜及逆行尿路造影证实的先天非梗阻性巨输尿管症静脉尿路造影的Ｘ线表现。结果：本症以输尿管近膀胱一段短于３．０ｃｍ保持正常管径的无动力非梗阻性狭窄，狭窄段以上输尿管继发性显著扩张为特征，扩张可延及肾盂肾盏。静脉尿路造影表现为主要诊断依据，狭窄段充盈显影呈“鸟嘴”状、“鼠尾”状，少数病例输尿管下段充盈终止呈“杵”状。输尿管行径靠近中线且较直，盆腔段显著扩张呈梭形。排空延缓是本症特征性尿流动力学改变。膀胱镜及逆行尿路造影有助于排除输尿管下段梗阻性疾病。结论：静脉尿路造影为诊断本症的主要方法和依据。     

腹直肌旁切口治疗合并髋关节功能障碍输尿管中段结石

目的观察经腹直肌旁切口治疗合并双侧髋关节功能障碍的输尿管中段结石临床疗效。方法回顾分析2009年10月~2013年12月我院10例合并双侧髋关节功能障碍的输尿管中段结石经腹直肌旁切口治疗的临床资料。结果结石取尽率100%,术后无结石残留、漏尿,肾功能恢复正常。术后3~6个月复查彩超、静脉肾盂造影,所有患者肾积水不同程度减轻,输尿管无狭窄。髋关节功能障碍无加重。结论经腹直肌旁切口是治疗输尿管中段结石一种有效方法,具有安全、对肌肉损伤小、疗效确切的优点,尤其对于合并双侧髋关节功能障碍的特殊患者,在体外震波碎石、输尿管镜碎石、经皮肾镜碎石较为困难时,是一种理想的选择。     

输尿管上端狭窄及囊肿并发巨大肾盂及多发结石1例

男,65岁,不明原因右腰背痛10年余,加重2周。X线平片见右上腹显示石榴籽样多发结石影;静脉肾盂造影,左肾盏肾盂输尿管显影正常,60 min右肾盏肾盂显影仍然浅淡,肾区见一囊袋状略高密度影,其内见石榴籽样多发结石影;输尿管逆行造影,见右肾盂重度积水扩张呈囊袋状垂向右下腹,大小约     

小剂量碘海醇IVP联合逆行尿路造影诊断输尿管狭窄

目的评价小剂量碘海醇静脉肾盂造影联合逆行尿路造影对输尿管狭窄的诊断价值。方法收集我院2007年1月-2012年12月临床高度怀疑输尿管狭窄的患者163例,其中49例经签署知情同意书人选A组,进行小剂量（10ml,0．2g／kg）碘海醇静脉肾孟造影,其他114例入选B组,行常规剂量碘海醇静脉肾盂造影。所有静脉肾盂造影输尿管不显影或显影不满意者加做逆行尿路造影。结果A组检出输尿管狭窄13例（26．5％）,联合逆行尿路造影检出输尿管狭窄29例（59．2％）;B组检出输尿管狭窄31例（27．2％）,联合尿路逆行造影检出输尿管狭窄66例（57．9％）。A、B两组静脉。肾盂造影对输尿管狭窄确诊率无明显差异（Х^2=0．008,P〉0．05）;联合逆行尿路造影,A、B两组对输尿管狭窄的检出率分别为85．7％、85．1％。结论小剂量与常规剂量碘海醇静脉肾孟造影对输尿管狭窄的检出无明显差异,但单纯静脉肾盂造影对输尿管狭窄的检出率低,需结合逆行尿路造影。小剂量碘海醇静脉肾盂造影具有风险小、成本低的优点,尤其适合合并肾功能不全的患者,可达到同等的检查目的,值得推广应用。     

经皮肾盂穿刺造影加逆行尿路造影诊断输尿管梗阻

目的探讨超声引导下经皮肾盂穿刺造影加上逆行尿路造影诊断输尿管梗阻的临床诊断价值。资料与方法 56例患者均经超声诊断为肾积水、输尿管积水,行静脉肾盂造影患侧肾、输尿管不显影,行逆行尿路插管造影剂不能充盈梗阻近端输尿管,后均行经皮肾盂穿刺造影加逆行尿路造影。结果 56例均经手术证实,其中13例肾盂输尿管交界处梗阻,11例输尿管上段梗阻,23例输尿管中段梗阻,9例输尿管下段梗阻。经皮肾盂穿刺造影加逆行尿路造影的诊断符合率100%。结论经皮肾盂穿刺造影加逆行尿路造影可清楚的显示肾盂和全段输尿管梗阻部位,弥补了静脉肾盂造影和逆行尿路造影的局限性。     

静脉增强肾皮质期MSCTU对非结石性尿路梗阻的诊断

目的:探讨多层螺旋CT静脉增强肾皮质期尿路成像(MSCTU)对非结石尿路梗阻的病因诊断价值.方法:对72例MSCT平扫结石阴性的梗阻性肾积水患者行肾脏三期扫描即肾皮质期、实质期及肾盂期扫描,将肾皮质期原始图像数据重建后传输至工作站进行图像后处理,获得多种3D重组图像再做出诊断,将诊断结果与临床或手术病理结果进行对照.结果:肾皮质期MSCTU图像结合轴面图像诊断输尿管结核16例,肾盂输尿管连接处狭窄18例,肾输尿管重复畸形1例,原发性输尿管癌15例,邻近部位恶性肿瘤侵犯输尿管7例,输尿管炎症5例(其中2例手术病理证实为输尿管息肉),梗阻性膀胱6例,结石排出后尿路扩张2例,肾输尿管重复畸形合并输尿管囊肿1例,血管压迫1例.均显示梗阻的部位,病变的形态、大小及尿路扩张情况.诊断敏感度100%,诊断符合率97.2%.结论:静脉增强肾皮质期MSCTU图像结合轴面图像对非结石性尿路梗阻疾病能准确定位和定性.     

先天性巨输尿管症的影像学诊断（附28例报告）

目的　提高对先天性巨输尿管症的认识和诊断。方法　作者总结了28例经尿路造影、B超、利尿性肾图等多种影像检查及手术病理证实的先天性巨输尿管症的静脉尿路造影及B超声像图表现。结果　本症以输尿管近膀胱段短于3cm保持正常管径的无动力非梗阻性狭窄,狭窄段以上输尿管继发性显著扩张为特征,扩张可延及肾盂肾盏。尿路造影、B超表现为患侧输尿管明显扩张,以中下段为著,可延及全程。狭窄段以上扩张的输尿管可呈杵状、蛇头状、纺锤状或鼠尾状。透视或B超适时观察见巨输尿管蠕动频率减低,蠕动幅度增大,向下传递间断。结论　静脉尿路造影为诊断本病的主要方法,B超、逆行尿路造影及膀胱镜为必要的辅助检查方法。     

婴幼儿先天性肾盂输尿管交界处狭窄的护理体会

先天性肾盂输尿管狭窄是小儿肾盂积水的常见原因,占小儿肾积水的85%～90%。我院自2010年7月～2011年7月对6例肾盂输尿管交界处狭窄致肾积水的患儿在全麻下实施了肾盂输尿管交界处吻合成形术,术后经过精心护理,取得满意效果,现将护理体会报道如下。1临床资料本组6例患儿,均为男性;年龄3个月零13d-2．5岁,平均7个月;左侧肾积水5例,双侧肾积水1例。6例患几经B超、静脉肾盂造影检查、MRU均提示肾盂扩张,肾实质变薄,不同程度的肾体积增大、积水。术后无明显发热,伤口对合愈合好,拔除尿管后可自行排尿,顺利出院。     

输尿管硬镜下气压弹道碎石术治疗输尿管中下段结石的体会

目的:探讨输尿管硬镜下气压弹道碎石技术治疗输尿管中下段结石的临床应用效果,提高治疗水平.方法:对183例经B超、静脉尿路造影、CT检查确诊为输尿管中下段结石的患者,行输尿管硬镜下气压弹道碎石治疗。结果:所有病例中180例一次性碎石成功,2例中段结石逆行进入肾盂,1例因输尿管结石远端先天性狭窄明显,术中输尿管镜插入困难而改为开放手术治疗,术中未发生输尿管穿孔、撕脱等严重并发症,术后肾积水改善明显,肾功逐步恢复正常。结论:输尿管硬镜下气压弹道碎石术仍是治疗输尿管中下段结石的有效方法。     

尿路梗阻磁共振水成像技术与逆行肾盂造影检查的对照观察

目的:比较磁共振水成像(MRU)和逆行肾盂造影(RP)检查对尿路梗阻性疾病的诊断价值.方法:对15例尿路梗阻性病变患者进行MRU和RP检查,并经病理证实,对两者进行对照分析.结果:15例尿路梗阻中输尿管肿瘤2例,先天性狭窄6例,输尿管结石4例,输尿管炎性狭窄3例,MRU与RP均能清晰显示输尿管的梗阻部位,定位诊断准确率相似,梗阻病因确诊率MRU高于RP.结论:MRU对输尿管梗阻性病变的定位、定性诊断准确率高,且无创伤,可以替代RP检查.尤其是对不能耐受RP检查患者应为首选的检查方法.     

Selective renal venography in the evaluation of a non-functioning hydronephrotic kidney.

A case is presented in which extreme hydronephrosis simulated absence of the right kidney. The hydronephrosis occurred as a result of surgical ligation of the right ureter 10 years previously. There was no visualization of the excretory system by intravenous urography or retrograde pyelography. Abdominal aortography did not show the renal artery. Selective renal venography revealed a patent venous bed with splaying and thinning of the intrarenal veins. The contribution of renal venography is discussed in clarifying cases in which the kidney and the renal artery were not visualized.     

磁共振尿路造影在临床泌尿道梗阻中的诊断价值

目的：评估磁共振尿路造影在临床泌尿道梗阻中的诊断价值。方法：回顾性对61例例泌尿系统梗阻患者的的MRU检查所见与手术和病理结果对照分析。结果：61例泌尿系梗阻患者，输尿管癌7例，输尿管结石8例，下腔静脉后输尿管1例，输尿管良性狭窄11例，先天性输尿管狭窄27例，膀胱癌侵及输尿管4例，泌尿系改道手术后再次发生良性梗阻患者3例，所有病例MRU均确定梗阻水平并且清晰显示梗阻端形态和特征。结论：NMR是一种安全、可靠、无创的检查方法，尤对IVU不显影或仅显示扩张的肾盏、肾孟影的重度肾积水病例或对比剂过敏的患者更有诊断价值。     

先天性巨输尿管症的X线与超声诊断(附19例分析)

目的：探讨X线与超声对先天性巨输尿管症的诊断价值。方法：回顾性分析了19例先天性巨输尿管症的静脉肾盂造影(IVP)、尿路逆行造影及超声影像资料。19例先天性巨输尿管症均进行了尿路造影和超声检查。其中3例术前做了CT检查，本组病例均经手术及病理证实。结果：巨输尿管症以其下端管腔无机械性梗阻的相对狭窄和狭窄段以上显著性扩张为特征。成人的扩张多不延及肾盂肾盏，小儿多数病例有肾盂肾盏扩张积水表现。早期扩张的下段可呈“纺锤状”或“杵状”。尿路造影透视和超声实时观察时，可见扩张输尿管蠕动频率减慢、幅度增大、向下传递间断。结论：超声因其具有诸多优点，可作为诊断巨输尿管症的首选的筛查方法。尿路造影检查，正确诊断率高，为本症术前的必查项目。两种检查方法联合应用可优势互补。     

B-mode ultrasound and the nonvisualizing kidney in pediatrics.

Ultrasonic definition of the kidney is independent of renal function and therefore capable of imaging impaired or dysplastic renal tissue, In 28 cases, B-mode scanning delineated one or both kidneys which failed to visualize during intravenous pyelography. Similar imaging of both kidneys was obtained in 10 cases of renal failure in which intravenous pyelography was not attempted. The presence and relative severity of hydronephrosis was established. In three cases of multicystic kidney, a diagnostic appearance was elicited. In these instances, in one additional case of renal dysplasia, and in three cases of severe obstructive uropathy, sonography provided the only presurgical definition of the abnormal kidney. Suspected kidney enlargement was rapidly confirmed in a case of renal vein thrombosis and excluded in a case of chronic renal failure. In both instances hydronephrosis was excluded. In 12 of the 38 cases, ultrasonic guidance was utilized for percutaneous renal biopsy.     

CT尿路造影对非结石性尿路梗阻疾病的诊断作用

目的评价CT尿路造影(CTU)对非结石性尿路梗阻疾病的诊断作用。方法40例非结石性尿路梗阻病例给予实质期、分泌期增强螺旋扫描。分泌期数据经第2次重建后在工作站以三维方式获得CTU影像。结果40例中，24例良性梗阻呈轻度或重度积水。18例先天畸形CTU呈现各自特征；4例输尿管炎表现为鸟嘴样狭窄，2例前列腺增生可见膀胱后壁压迹。16例肿瘤患者梗阻端呈截断或锥状狭窄伴局部软组织影，12例尿路中度积水，4例重度积水。其中4例呈双侧积水。对6例一侧无分泌功能者，可采用最小强度投影等予以显示，并与对侧最大强度投影像等整合。结论CTU对非结石性尿路梗阻疾病的诊断具有良好的效果。     

Retrograde or antegrade double-pigtail stent placement for malignant ureteric obstruction?

AIM: To determine the optimum approach for double-pigtail stent placement in malignant ureteric obstruction. PATIENTS AND METHODS: Retrograde stent placement was attempted in a consecutive series of patients presenting with malignant ureteric obstruction. If retrograde stent placement was unsuccessful, percutaneous nephrostomy was performed immediately followed by elective antegrade stent placement. Identical digital C-arm fluoroscopy for image-guidance and conditions for anaesthesia and analgesia were employed for both retrograde and antegrade procedures. Identical 8 Fr (20-26 cm) double-pigtail hydrophilic coated stents were used for each approach. RESULTS: Retrograde placement was attempted in 50 ureters in 30 patients {19 male, 11 female, average age 61.4 yr (range 29-90 yr)} over a 24-month period. The success rate for retrograde ureteric stent placement was 50% (n = 25/50). Technical failures were due to failure to identify the ureteric orifice (n = 22), failure to cross the stricture (n = 1), failure to pass the stent (n = 1) and failure to pass a 4 Fr catheter (n = 1). Antegrade placement was attempted in 25 ureters with a success rate of 96% (n = 24/25). Failure in the one case was due to inability to cross an upper third stricture secondary to pyeloureteritis cystica. CONCLUSION: It is suggested that retrograde route should be the initial approach if imaging shows no involvement of ureteric orifice (UO), when nephrostomy is technically very difficult or in cases of solitary kidney. The antegrade route is preferred if imaging shows tumour occlusion of the UO or if there is a tight stricture very close to the uretero-vesical junction (UVJ) making purchase within the ureter difficult for crossing the stricture.     

MR urography of obstructive uropathy: diagnostic value of the method in selected clinical groups

The aim of the study was to evaluate the role of MR urography (MRU) in the diagnosis of obstructive uropathy in selected groups of patients. The groups involved following pathologies: calculi; strictures of ureteropelvic junction (UPJ); benign and malignancy-induced ureterostenosis. Sixty patients with clinical diagnosis of obstructive uropathy were subjected to static fluid MRU (sMRU) with the use of 3D turbo spin echo (TSE) sequence in a 0.5-T magnet. The examination was completed with conventional MR sequences and in 12 cases additionally with sequences after the administration of Gd-DTPA and excretory MRU. The results were compared with intravenous urography (IVU), CT, US, clinical and histopathological data. The degree of the urinary tract dilatation as well as the level and type of obstruction were estimated. In patients with urolithiasis sMRU correctly depicted the degree of ureterohydronephrosis in 85%, in cases of UPJ stenosis and malignancy-induced ureterostenosis in 100% and in the group of benign ureterostenosis in 91% of patients. Determination of obstruction level in patients with stones was adequate in 92% and in cases of non-calculous ureteral strictures in 100% of patients. The sMRU sequence alone could not specify the nature of obstruction except 1 case of bladder carcinoma. Filling defects in ureters visible on MR urograms were verified with IVU or CT to exclude intrinsic tumours. Completed with conventional MR sequences sMRU enabled the depiction of solid mass or infiltration in 83% cases of malignancy-induced ureterostenosis, and in the remaining groups of patients neoplastic process was excluded in 91%. In conjunction with excretory MRU and conventional MR images sMRU appears to be a highly useful technique in assessment of obstructive uropathy, especially that of non-calculous origin. Among different clinical applications MRU is superior in the evaluation of dilated urinary tract in altered anatomical conditions (e.g. in patients with ileal neobladder). Electronic Publication