输尿管阴性结石的常用影像学诊断方法比较

目的：探讨输尿管阴性结石的合理、有效诊断方法。方法：对72例输尿管阴性结石患者的常规B超、排泄性尿路造影（IVU）、逆行肾盂造影（RGP）和CT平扫结果进行比较分析。结果：B超检查72例,提示结石56例,误诊2例,漏诊14例;IVU检查65例,确认结石3例,提示各种可能为结石的征象32例;RGP检查38例,确认结石27例,疑诊3例,失败8例;CT检查42例,检出结石41例。结论：对B超和（或）IVU提示的结石可疑部位行CT平扫是诊断输尿管阴性结石的准确、无创、相对价廉的可行方法。     

螺旋CT输尿管重建诊断输尿管阴性结石

目的探讨螺旋CT输尿管重建对输尿管阴性结石的诊断价值。方法从2002年5月至2004年10月，36例临床表现为肾绞痛，镜下血尿．B超提示或疑似输尿管结石．腹部平片（KUB）及静脉尿路造影（IVU）均未显示结石的患者行螺旋CT检查。将所获资料传至工作站，采用输尿管冠状面曲面重建（CPR）。结果36例病人全部显示出输尿管结石，诊断准确率为100％。结石直径0．2—1．8cm，其中12例结石小于0．5cm。左侧输尿管结石18例．右侧15例，双侧3例；结石位于输尿管上段8例，中段15例，下段13例。36例重建图像均清楚地显示出输尿管全程，结石在输尿管腔内的位置、大小、形状及结石周围组织的结构形态。结论螺旋CT输尿管重建诊断输尿管结石快捷、准确，它可能是诊断输尿管阴性结石最有价值的方法。     

急性上尿路结石梗阻的影像学分析

目的：探讨超声、腹部平片（ＫＵＢ）、静脉尿路造影（ＩＶＵ）对急性输尿管结石梗阻的诊断价值。方法：回顾性分析３５２例急性输尿管结石梗阻患者的Ｂ超、利尿性Ｂ超、ＫＵＢ、ＩＶＵ的诊断结果。结果：对肾积水的诊断,常规Ｂ超诊断率８３．２％（２９３／３５２）,而５９例可疑病例利尿性Ｂ超的诊断率７９．７％（４７／５９）,利用常规Ｂ超加利尿Ｂ超检查,对梗阻性肾积水的诊断率９６．６％（３４０／３５２）;对输尿管结石     

输尿管结石的影像学分析(附124例报告)

目的探讨B超、腹平片(KUB) 静脉肾盂造影(IVU)、CT对输尿管结石的诊断价值。方法回顾性分析了本院124例输尿管结石患者的B超、KUB IVU的诊断资料。结果B超诊断率为78.2%,KUB IVU诊断率为90.3%,KUB IVU综合B超诊断率达96.8%。结论B超、KUB IVU综合对输尿管结石有很高的诊断价值。CT是B超及KUB IVU的补充检查方法。     

静滴造影定位体外碎石治疗输尿管阴性结石

目的 探讨输尿管阴性结石经体外冲击波碎石(ESWL)治疗的定位方法.方法 对45例输尿管阴性结石患者,采用静滴造影辅助定位后行ESWL治疗,碎石前经B超或者CT证实结石存在.结果 本组病例经过1～2次ESWL治疗后,结石完全排出,B超及IVU检查梗阻消失.结论 输尿管阴性结石因X线不显影,而又没有条件行B超定位时,静滴...     

原发性输尿管癌的早期诊断与治疗(附26例报告)

目的：提高原发性输尿管癌的诊治水平。方法：回顾性分析26例原发性输尿管癌临床资料，比较各种检查方法，总结诊治经验。结果：26例术后均行病理检查证实为移性细胞癌。术前经B超、IVU、膀胱镜及逆行肾盂输尿管造影、CT、MRU等确诊24例(92．3％)。结论：联合应用B超、IVU、膀胱镜、逆行肾盂输尿管造影和CT、MRU检查方法，可提高原发性输尿管癌的诊断符合率。膀胱镜、逆行肾盂输尿管造影是原发性输尿管癌的最基本的检查手段。治疗以手术为主。     

64层螺旋CT平扫曲面重建技术对急性输尿管结石的诊断价值

目的：探讨64层螺旋CT曲面重建（CPR）技术对急性输尿管结石的诊断价值。方法：35例疑为输尿管结石的患者,男24例,女11例,年龄23-79岁,均行B超和64层螺旋CT平扫检查,将CT原始资料传送至工作站,用多平面重建（MPR）及CPR技术进行图像后处理,比较CT与B超诊断输尿管结石的阳性率。结果：35例输尿管结石患者中,CT诊断输尿管结石32例（91．4％）,B超诊断输尿管结石20例（57．1％）,CT对输尿管结石的诊断率高于B超（r=7．56,P〈0．01）;CPR使扩张的肾盂、输尿管全程显示在一幅图像上,便于全面观察结石的形态、大小和位置。结论：64层螺旋CT的CPR技术方便快捷、诊断准确率高,不需使用对比剂,尤其适用于肾绞痛患者的检查。     

输尿管镜在上尿路阴性结石诊断中的应用价值

1998年10月～2002年3月本院经KUB IVP、B超、尿路逆行造影、输尿管镜检查，确诊上尿路结石309例，其中68例阴性结石，B超确诊21例，尿路逆行造影确诊5例，输尿管镜确诊42例。本就输尿管镜在上尿路阴性结石诊断中的价值总结报告如下。     

输尿管镜下钬激光治疗输尿管阴性结石

目的：提高输尿管阴性结石的诊治水平。方法：对41例B超、静脉尿路造影（IVU）、CT等明确诊断或间接诊断为输尿管阴性结石的患者,行输尿管镜检及钬激光碎石治疗。结果：41例均成功解除梗阻,取得满意疗效,其中39例为一次性碎石成功,2例结石部分逆行入肾盂,术中未发生输尿管黏膜撕脱、输尿管穿孔等严重并发症。术后随访肾积水明显改善。结论：输尿管镜下钬激光碎石术是治疗输尿管阴性结石的理想方法之一。     

合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石疗效观察(附138例报告)

目的:探讨合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石的临床效果。方法:术前138例患者经B超、IVU、CT检查确诊输尿管阴性结石。采用IVU联合应用阿托品针、碘海醇针合剂经输尿管导管持续微泵泵入,行逆行造影(RGU)辅助,经X线定位后,明确结石的部位及大小后行ESWL治疗。留置输尿管导管综合排石治疗3～5天,观察临床碎石效果。结果:本组138例患者经1次ESWL治疗后2～4周,121例(87.8%)结石完全排净,第2次ESWL治疗结石排净10例(7.2%),第3次ESWL治疗结石排净2例(1.4%);2例(1.4%)形成"石街",需行输尿管镜取石;无效3例(2.2%),行开放手术取石,证实结石有炎性肉芽包裹。结论:合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石临床疗效确切,术后留置输尿管导管逆行灌注冲洗利于排石。     

计算机断层扫描螺旋尿路成像与仿真内窥镜技术的临床应用

目的 探讨螺旋CT尿路成像（SCTU）与CTVE）的检查方法、成像技术以及在泌尿外科疾病中的应用价值,提高诊断水平。方法 应用螺旋CT对46例泌尿系统疾病患者（包括肾肿瘤2例,肾盂旁囊肿2例,输尿管结石6例,输尿管狭窄4例,输尿管肿瘤2例,重复肾重复输尿管畸形1例,膀胱肿瘤28例,膀胱子宫内膜异位症1例）行容积扫描,所得数据在工作站利用软件进行后处理,获得泌尿系立体图像;并对6例输尿管疾病、29例膀胱疾病患者进行了CT仿真内窥镜（CTVE）成像。所有图像均与B超、静脉尿路造影、逆行肾盂造影、常规CT扫描、膀胱镜检查等比较。并将术中所见或病理结果作为诊断的金标准。结果 所有患者均取得了高质量的泌尿系图像,除1例膀胱肿瘤（肿瘤直径为4mm）漏诊外,其余患者均得到了明确诊断,并与手术或病理结果相符合。结论 SCTU与CTVE是较可靠的非侵入性检查手段,具有一定的优越性,可作为泌尿系常规检查方法的有益补充。     

THE VALUE OF UNENHANCED HELICAL COMPUTERIZED TOMOGRAPHY IN THE MANAGEMENT OF ACUTE FLANK PAIN

Purpose

We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction.

Materials and Methods

During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.

Results

Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications.

Conclusions

Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.     

Staging of ureteral transitional cell carcinoma by CT and MRI

Intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease. Computed tomography (CT) and magnetic resonance imaging (MRI) delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy. In selected cases, CT and MRI are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction. Five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative CT and/or MRI evaluation and staging.     

Clinical characteristics of ureteral calculi detected by nonenhanced computerized tomography after unclear results of plain radiography and ultrasonography

PURPOSE: Prospective non-enhanced computerized tomography (CT) was performed for patients presenting with renal colic and showing negative or equivocal results on plain x-ray of the kidneys, ureters and bladder (KUB) as well as ultrasonography (US) to evaluate the usefulness of plain CT. We also evaluated the clinical characteristics of urinary calculi detected under such conditions. MATERIALS AND METHODS: Between January 2000 and June 2002, 560 patients presented with acute unilateral renal colic. Of these patients 238 negative or equivocal for ureteral calculus on KUB and US underwent non-enhanced CT. The diagnostic value of plain CT in patients with negative or equivocal KUB and US was determined, and results and other clinical findings were compared. Clinical characteristics of ureteral stones detected by plain CT were compared with those of stones diagnosed by KUB and US. RESULTS: By plain CT 143 (60.1%) and 6 (2.5%) cases of pain were determined to have been caused by ureteral stones and other pathogeneses, respectively. No definitive diagnosis was obtained in 89 (37.4%). Stone size detected by plain CT was significantly smaller than controls (3.77 vs 6.37 mm, p <0.0001) and tended to be located in the middle or lower ureter (76.2% or 109 of 143 vs 52.2% or 168 of 322, p <0.0001). Symptoms spontaneously improved in 137 (95.8%) after conservative therapy while 6 underwent intervention, a rate significantly lower (p <0.0001) than controls (32.9% or 106 of 322). CONCLUSIONS: Non-enhanced CT is a useful modality for diagnosis of patients presenting with acute renal colic but whose results are negative or equivocal on KUB and US. Excretory urography is rarely needed because stones undetected on KUB and US tend to be small and in the middle or lower ureter, and spontaneous passage is expected.     

原发性输尿管癌的诊断

目的:提高原发性输尿管癌术前诊断水平。方法:对1973～1997年收治的50例原发性输尿管癌的诊断经验进行总结。结果:50例均作IVU检查,其中31例患侧肾脏不显影,仅有7例显示输尿管充盈缺损或狭窄。26例行逆行造影,有16例输尿管充盈缺损或狭窄。48例作B超检查,有43例显示肾积水,35例显示输尿管扩张积水,25例显示输尿管低回声或略强回声的实质性肿物。27例作CT检查,有17例显示输尿管软组织密度实质性肿物。44例作膀胱镜检查,有8例肿瘤自输尿管管口脱出,11例患侧输尿管管口喷血。47例作尿脱落细胞学检查,阳性率为40.4%。结论:术前联合应用IVU、B超、逆行造影、CT、膀胱镜和尿脱落细胞学等检查可提高原发性输尿管癌的正确诊断率。     

上尿路移行细胞癌的诊断与治疗（附39例报告）

目的探讨上尿路移行细胞癌的诊治方法。方法回顾性分析39例上尿路移行细胞癌患者的临床表现及诊治方法。结果39例患者均行手术治疗,术后病理检查证实29例为肾盂移行细胞癌,10例为输尿管移行细胞癌。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、尿脱落细胞学及输尿管镜等检查,术前诊断符合率为92.3%（36/39）。35例患者获得随访6个月-12年,6例术后出现膀胱移行细胞癌,5例死于肿瘤进展。结论B超、IVU、CT可作为上尿路肿瘤的常规检查,IVU显影不佳时逆行肾盂造影可作补充,输尿管镜配合组织活检准确性极高。根治性肾输尿管切除术效果较好,术后应行膀胱灌注治疗及定期膀胱镜检查。     

瞬时X线联合B超在复杂经皮肾镜取石术中的应用体会

目的:探讨瞬时X线联合B超引导经皮肾穿刺定位在较为复杂的经皮肾镜取石术(PCNL)中的应用价值。方法:回顾2012年3月~2013年10月我院收治的69例肾结石患者临床资料,其中肾脏轻度积水25例,肾脏旋转不良12例,肾脏无明显积水8例,完全鹿角形结石6例,重复肾6例,术中逆行造影及人工积水肾建立失败4例,肾结石术后瘢痕肾5例,肥胖患者2例,肾下垂患者1例。术中常规给予输尿管置管行逆行造影并建立人工积水肾,采用C型臂瞬时X线照相联合B超引导建立经皮肾穿刺通道。结果:69例患者均穿刺成功,建立F14~18通道,建立时间10~35min,术中X线暴露次数2~5次。其中肾脏轻度积水25例、肾脏无明显积水8例、完全鹿角形结石6例由间断瞬时X线定位为主,辅助B超定位以避开主要血管及领近器官或辅助建立多通道;肾脏旋转不良12例、重复肾6例、肾结石术后瘢痕肾5例、肥胖患者2例、肾下垂患者1例由B超定位为主,辅助瞬时X线定位以确保穿刺线通过肾盏穹窿部;术中逆行造影及人工积水肾建立失败4例,由B超定位穿刺针进入肾脏集合系统,经穿刺针推注造影剂显示肾盂肾盏,用第二穿刺针在瞬时X线定位下建立目标肾盏的穿刺通道。64例为Ⅰ期手术,5例行Ⅱ期手术,清石率为96.8%,无严重并发症发生。结论:对于较为复杂的PCNL,瞬时X线联合B超的定位技术能够结合两种定位方法的优势,建立安全、有效的穿刺通道,提高清石率,减少手术并发症的产生,同时减少患者及医生在手术中X线的暴露时间。