超声观察与分析32例输尿管结石急性梗阻并同侧肾周积液

目的:观察输尿管结石急性梗阻患者肾周积液的超声表现,分析其病理基础。方法:对354例急性肾绞痛患者中32例超声发现肾周积液的声像图进行回顾性分析。结果:32例输尿管内均发现结石,梗阻以上输尿管不同程度扩张,均可见不同程度肾盂积水,同侧肾周可见局限性或条带状无回声暗区。结论:超声检查能准确及时地诊断输尿管结石急性梗阻并发肾周积液,并能动态观察治疗前后的变化,是观察临床疗效的重要手段。     

临床型肾结核的超声声像图特征分析

目的探讨临床型肾结核的超声声像图特征。方法回顾分析42例50个病肾肾结核住院患者的病例资料,总结肾结核的超声声像图特征。结果超声诊断符合率62%。主要超声声像图特征:(1)肾实质内单发或多发低回声或无回声结构31个肾,占62%;(2)肾盂肾盏扩张27个肾,占54%;(3)合并输尿管结核18例,21个肾,占42%;(4)肾萎缩并钙化3个肾,占6%。结论临床型肾结核超声表现呈多样性,但仍有一定特征,结合临床可作出初步诊断。     

急性肾损伤不同时间声像图特征分析

目的 探讨急性肾创伤后不同时间段B超检查的声像图特征。方法 将96例急性肾创伤声像图按不同检查时间分为I、Ⅱ2组。I组为伤后30－90分钟检查，Ⅱ组为伤后90－180分钟检查，并将两组急性肾创伤声像图特征进行比较分析。结果 I、Ⅱ2组的声像图分类构成差异有显著性意义，I组低回声明显高于Ⅱ组，而Ⅱ组的混合性回声高于I组（P＜0．001）。I、Ⅱ2组分别与同组各类型声像图比较，I组的低回声型和Ⅱ组的混合型回声均分别高于同组的其它类型，差异有显著性意义（P＜0．001）。结论 急性肾创伤因超声检查的时间不同，声像图有较大的不同，最早表现以低回声型为主，然后向混合性回声型转变。     

超声在急性尿潴留插管导尿术中对导尿管的监测意义

目的探讨超声在急性尿潴留插管导尿术中对导尿管监测的意义。方法回顾性分析了超声监测下行插管导尿术的34例急性尿潴留患者资料。结果(1)超声可显示导尿术中导尿管体内段特征性的双线状或粗线状稍强回声,并可判断后尿道的走行;(2)超声可通过对导尿管前端回声观察准确判断导尿管前端到达的位置和提高后尿道结石的诊断率;(3)超声可通过在膀胱内显示气囊已扩张,导尿管呈特征性的单个穿葫芦状的声像图表现来作为导尿术成功的依据。结论 超声对急性尿潴留插管导尿术的监测能显示导尿管前端,体内段以及气囊的位置和形态,为临床操作提供一个可视的手段,提高插管导尿术的成功率,是一种简单易操作的方法。     

膀胱肿瘤的声像图分析及超声诊断价值

目的通过分析膀胱肿瘤的声像图表现,探讨超声显像在诊断膀胱肿瘤中的应用价值。方法回顾性分析39例膀胱肿瘤的声像图表现,结合彩色多普勒血流成像(CDFI)及腔内超声(经直肠或经阴道)技术,与膀胱镜及手术病理结果进行对照。结果35例为恶性,4例为良性,1例漏诊,1例误诊,超声诊断阳性率97.4%,准确率94.9%,误漏诊率5.1%。结论超声对膀胱肿瘤的早期诊断具有重要的临床应用价值,彩色多普勒及腔内超声可作为膀胱肿瘤的有效补充检查方法。     

超声监测经皮肾镜碎石术的意义

目的探讨超声监测经皮肾镜碎石术的意义.材料和方法对31例肾结石患者的经皮肾镜碎石术进行超声监测,分析和总结不同时期的声像图表现及其监测价值.结果超声实时全程监测26例,5例改开放取石术.全程监测者术前声像图能清晰显示肾结石的位置,大小,肾积水的范围;术中声像图能显示穿刺和碎石过程中穿刺针针尖和气压弹道碎石机撞针前端强回声位置的改变以及肾、肾周回声的相关变化,即时引导穿刺和碎石;术后声像图能显示术后肾脏,肾周回声情况以及肾内有无结石残留.结论超声能实时引导穿刺针的进入,提示气压弹道碎石机撞针前端位置及肾脏和肾周情况,观察术后有无结石残留,为临床降低手术风险、选择合适的治疗方式提供帮助.     

鹿角形及堆积的多发性人肾结石在离体猪肾中的声像图研究

目的　观察分析鹿角形及堆积的多发性人肾结石在离体猪肾中的声像图表现 ,以期为临床超声减少对鹿角形肾结石的误诊与误导。方法　 (1 )用新鲜猪肉包裹离体猪肾建立模型。 (2 )选取从人肾中取出的 1枚最大径 2 .4cm的鹿角形结石及 4枚最大径 <1cm的小结石 ,改变鹿角形结石方位、小结石堆积的形态 5次 ,用镊子分别送入不同的猪肾盂内 ,进行超声检查 ,观察声像图表现。 (3 )剖开离体猪肾 ,将鹿角形结石及堆积的多发性人肾结石在离体猪肾盂内的形态、大小与其声像图进行对比分析。结果　 (1 )离体猪肾声像图与活体人肾声像图极相似。 (2 )鹿角形及堆积的多发性肾结石在离体猪肾中声像图相同点为 :聚集成一团的、多个大小不一、断续、参差、错位的强回声光团 ,后伴声影。 (3 )鹿角形及堆积的多发性结石声像图不同点为 :鹿角形结石声像图中单个最宽强回声≥ 1cm ,其后声影宽、明显 ,多个声影间连续 ;堆积的多发性结石声像图中单个最宽强回声 <1cm ,其后声影窄、弱 ,多个声影间不连续。 (4 )声像图随小结石堆积的形态、鹿角形结石的方位均有不同的表现 ,超声能较准确地测量结石最大径及单个最宽强回声大小 ,但不能准确推测结石的形态。结论　多切面超声检查可显示出鹿角形及堆积的多发性人肾结石在离体猪肾中?     

细粒棘球蚴病的超声检查与分类

目的探讨细粒棘球蚴病的超声检查与分类的临床意义。资料与方法实时超声观察细粒棘球蚴病各类型的分布及声像图表现。结果按病灶部位分为(1)实质性脏器(肝、脾、肾、甲状腺、乳腺、子宫)包虫囊肿244例(72.6％);(2)含气脏器(肺)包虫囊肿65例(19.3％);(3)空腔脏器(腹腔、膀胱、卵巢)包虫16例(4.8％);(4)肌肉(腹直肌、股四头肌、腓肠肌)包虫囊肿6例(1.8％);(5)骨、关节部位(上颌骨、膝关节)包虫囊肿5例(1.5％)。根据包虫病囊肿的病理基础分为三种类型(1)单纯囊;(2)多子囊;(3)继发征象。结论五类三型分法有助于包虫病的诊断,鉴别诊断及治疗,具有十分重要的临床价值。     

乳腺导管内癌超声分型与病理相关性

目的研究乳腺导管内癌的超声声像图特点,总结不同超声分型的导管内癌的病理分型,探讨超声在导管内癌中的诊断价值。方法回顾性分析98例经我院手术病理证实的导管内癌病例,根据其声像图特征分为：①导管扩张型;②团块型;③类腺病型;④单纯钙化型;⑤无异常表现型,比较不同声像图分型的病理特征和临床表现。结果乳腺导管内癌声像图表现具有多样性,不同的超声分型具有不同的临床表现,存在不同的病理结果。结论不同类型的乳腺导管内癌其临床检出率有一定的差异,结合临床表现可以提高诊断率,在超声检查基础上结合纤维乳管镜及乳腺X线摄片检查可大大提高诊断的正确性。     

肾移植后使用免疫抑制剂所致肝毒性的超声表现

目的　探讨同种异体尸肾移植后使用免疫抑制剂引起的肝毒性的声像图特征。方法　使用B型超声诊断仪观察应用环孢素A为主的免疫抑制剂 ,临床诊断为肝中毒的 2 9例患者肾移植术前后肝胆的超声表现。结果　肝回声不同程度弥漫性增强 2 3例 ,脂肪肝表现 6例 ,胆囊壁增厚≥ 0 3cm 2 1例。肝中毒 6 9% (2 0 / 2 9)发生在 3个月内。结论　免疫抑制剂引起的肝毒性的声像图表现以肝回声弥漫性增强、胆囊壁增厚、部分胆囊腔透声差为主 ,对临床诊断肝中毒有重要辅诊作用 ,提示肾移植术后尤其 3个月内除定期超声观察移植肾外 ,也应同时观察肝胆的声像图表现以供临床医生参考 ,结合肝功能检验结果及时调整药物剂量     

Spontaneous extraperitoneal rupture of the urinary bladder in children

The authors describe two children who had spontaneous extraperitoneal rupture of the urinary bladder into the retropubic space secondary to acute urinary retention following lower urinary tract surgery. One also had urinary ascites. In one, the urinoma was initially mistaken for the bladder during ultrasonography. In both cases, the diagnosis of bladder rupture was not considered initially because of a lack of familiarity with the occurrence of this entity in children.     

Acute urinary retention caused by vesical diverticula

Two children with acute urinary retention due to obstructing bladder diverticula are presented. This is an extremely rare but significant complication of congenital bladder diverticulum. The possible mechanisms of this complication are discussed. Voiding cystourethrography can provide the correct diagnosis.     

Perirenal fluid in renal parenchymal medical disease ('floating kidney'): clinical significance and sonographic grading.

AIM: To study the clinical significance and radiologic features of perirenal fluid in patients with renal parenchymal disease. MATERIALS AND METHODS: During the previous 5 years, nine patients were found to have perirenal fluid on sonography associated with renal parenchymal medical disease. The clinical, radiological, histopathological and laboratory data were analysed. RESULTS: The perirenal fluid is a spontaneous subcapsular transudate in patients suffering from a nephropathy with a sodium retention state, with or without renal failure. Three sonographic patterns of perirenal fluid were observed: grade 1 is a thin layer of perirenal fluid; grade 2 is a moderate amount of perirenal fluid collection with indentations of the renal parenchyma and strands in the fluid, grade 3 is a large fluid collection surrounding the kidney. CONCLUSION: The perirenal fluid represents a sign of sodium retention state and oedema in patients with intrinsic renal parenchymal medical disease which may be caused by several nephropathies.     

Quality of Life and Clinical Symptom Improvement Support Prostatic Artery Embolization for Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia

PurposeTo show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH).Materials and MethodsThis was a single-center prospective study of PAE in 11 patients with BPH managed with indwelling urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300–500-μm Embosphere microspheres.ResultsThe rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4–25 days after PAE (mean, 12.1 d). No major complications were observed. Follow-up ranged from 19 to 48 months. In an asymptomatic patient, a discrete area of hypoperfusion suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8±2.1; P = .04), no erectile dysfunction was observed, and QoL improved significantly (mean, 0.4±0.5; P = .001) using the paired t test.ConclusionsPatients with severe symptoms and acute urinary retention caused by BPH can be treated safely by PAE, which improves clinical symptoms and QoL.     

Perirenal Fluid in Renal Parenchymal Medical Disease (‘Floating Kidney’): Clinical Significance and Sonographic Grading

AIM: To study the clinical significance and radiologic features of perirenal fluid in patients with renal parenchymal disease. MATERIALS AND METHODS: During the previous 5 years, nine patients were found to have perirenal fluid on sonography associated with renal parenchymal medical disease. The clinical, radiological, histopathological and laboratory data were analysed. RESULTS: The perirenal fluid is a spontaneous subcapsular transudate in patients suffering from a nephropathy with a sodium retention state, with or without renal failure. Three sonographic patterns of perirenal fluid were observed: grade 1 is a thin layer of perirenal fluid; grade 2 is a moderate amount of perirenal fluid collection with indentations of the renal parenchyma and strands in the fluid, grade 3 is a large fluid collection surrounding the kidney. CONCLUSION: The perirenal fluid represents a sign of sodium retention state and oedema in patients with intrinsic renal parenchymal medical disease which may be caused by several nephropathies. Haddad, M. C.et al. (2001). Clinical Radiology56, 979–983.     

Urological complications after kidney transplantation.

The uroradiological changes and complications with 110 patients who did undergo a total of 119 renal transplantations are discussed under the following 4 topographical headings: perirenal and intrarenal, ureter including the anastomosis, bladder, urethra. In our material we found a lymphocele in 1 patient, papillary necrosis in 3, ureteral obstruction in 6, urinary leakage in 23, reflux in a total of 23, renal calculi in 1 and bladder concrements in 1.     

Bladder diverticula and Menkes' syndrome.

Multiple unusual diverticula of the bladder were observed in 3 of 4 children with Menkes' syndrome. This abnormality of the bladder in children with the kiky hair syndrome has only recently been recognized. The diverticula are best visualized on cystographic studies. The clinical manifestation which led to roentgen evaluation of the urinary tract in the 3 children was urinary tract infection or urine retention. Though the etiology of these diverticula is unknown, evidence is presented to suggest that they are acquired.     

Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates. Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters. A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome. PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.     

急性胰腺炎累及肾周间隙的MRI研究

目的:研究急性胰腺炎(AP)向肾周间隙扩展的MRI表现,以及肾周间隙受累与AP严重程度的关系.方法:回顾性分析119例急性胰腺炎患者的MRI表现.每例AP患者在MRI上的严重程度用MRI严重程度指数(MRSI)进行分级,MRS10～2分为轻症,3～6分中症,7～10分为重症.在MRI上观察肾周间隙有无受累,并对受累程度分级:无受累记为0分,肾周间隙内条索状高信号记为1分,积液记为2分.分析肾周间隙受累程度与MRSI的相关性.结果:119例急性胰腺炎中,轻症急性胰腺炎例48例,中症59例,重症急性胰腺炎12例.73.95%(88/119)的AP患者在MRI上有肾周间隙受累,表现为肾周间隙内条索状、斑片状或大片状异常信号.其中轻症急性胰腺炎肾周间隙受累率47.92%(23/48),中症为91.52%(54/59),重症为91.67%(11/12).肾周间隙MRI评分为1分时在轻症为41.67%(20/48),中症及重症为19.72%(14/71)(χ~2=7.249,P=0.007);肾周间隙MRI评分为2分者轻症和中症共为42.06%(45/107),而在重症为75.00%(9/12)(χ~2=4.724,P=0.030).在MRI上肾周间隙受累的严重程度与MRSI成正相关(r=0.714,P=0.000).结论:在MRI上急性胰腺炎肾周间隙受累率高于文献报道的CT上的受累率,肾周间隙受累反映了AP的严重程度.