临床拟诊为独肾患者的影像学诊断

目的：探讨腹部影像检查表现为“独肾”患者的全腹部及盆腔CT和／或MRI影像特征及其发病规律。方法：回顾性分析2007年-2011年腹部影像呈“独肾”表现的48例患者的腹盆腔CT或MRI检查资料。年龄1个月～78岁（其中30岁以下37例）,男17例,女31例。其中行CT检查36例,MRI检查12例。结果：48例中先天性孤立肾7例,一侧发育正常的异位肾（低位肾）2例,一侧肾发育不良并低位4例,余35例均合并其它泌尿生殖系异常（72％）,均经临床或手术证实。35例中肾发育不良并低位及各种输尿管异常14例;肾缺如并同侧精囊囊肿（Zinner’s syndrome）7例;肾缺如或肾发育不良加子宫发育异常12例;多重复杂变异2例。影像特征和发病规律：①肾缺如或发育不良常合并其它泌尿生殖道畸形,大部分为同侧泌尿生殖系异常。②肾缺如常合并生殖系异常,而肾发育不良时多见泌尿系（尤其是输尿管下段）异常。③发育不良的肾几乎都出现在输尿管走行区,体积一般小于正常,大部分为低位（腰3椎体水平以下至盆腔内）。④性别特异性：男性为Zinner综合征（中肾管未发育导致肾缺如,残留于精囊形成囊肿）,女性出现多种子宫异常。输尿管异常男女均可发生,女性更易同时出现输尿管异位开口。结论：对于初诊腹部影像学表现为“独肾”的患者,全腹部及盆腔影像学检查是非常必要的,可进一步明确诊断。这类患者常合并泌尿生殖系异常,其病变位置、病变类型有一定规律,应重点观察同侧输尿管、精囊和子宫。     

微创经皮肾穿刺联合输尿管镜下U100激光碎石术治疗婴幼儿肾结石

目的探讨微创经皮肾穿刺联合输尿管镜下碎石术治疗婴幼儿肾盂结石的疗效和安全性。方法 8～36月龄婴幼儿单侧肾盂结石10例,全麻后经尿道从患侧输尿管内逆行置入F4输尿管导管;从11肋间隙与腋后线相交处,在B超或C臂X线机引导下穿刺至肾盂,以能量密度120mJ/cm2,脉冲频率5～10HzU100倍频双波长脉冲激光将结石粉碎,从输尿管导管冲出碎石,留置F4～F6单"J"管7～10d。结果 10例患者均一期穿刺取石成功,所有患者均采用单通道,结石1期清除率100.0%。1例患儿因结石位于肾盂和肾下盏采用C臂X光机定位,9例采用B超引导下定位。手术时间30～50min,平均手术时间40min。无输血、尿外渗病例,无开放手术。结论微创经皮肾穿刺联合输尿管镜下U100倍频双波长脉冲激光碎石术治疗婴幼儿肾结石安全、有效。     

Percutaneous transluminal renal angioplasty in the patient with a solitary functioning kidney

Since the introduction of percutaneous transluminal renal angioplasty, it has become established as an effective treatment for the correction of renovascular hypertension or the preservation of renal function. However, there has been a general reluctance to use it or other interventional procedures in any patient with a solitary functioning kidney. We attempted renal angioplasty in 11 patients each of whom had a solitary functioning kidney. All 11 had had either a previous contralateral nephrectomy or an autonephrectomy from chronic arterial occlusion. The patients ranged in age from 42 to 81 years. In nine of the 11 patients, a catheter was negotiated across the stenosis, and the lesion was dilated successfully. In two, the lesion could not be crossed. In the group of nine patients whose lesions were dilated successfully, clinical follow-up (2-180 weeks) revealed that hypertension was cured in four and improved in five. Of the two patients in whom angioplasty was not possible, one required emergency renal bypass surgery and the other had no change in renal status. Renal function test results after the procedure were variable and did not correlate with decreases in blood pressure. We conclude that percutaneous renal angioplasty is a satisfactory alternative to surgery for the treatment of renovascular hypertension or the preservation of renal function in a patient with a solitary functioning kidney.     

Indwelling ureteral stents: percutaneous management of complications

Complications of indwelling ureteral stents were managed percutaneously in 13 patients. These complications consisted of three fractured, three heavily encrusted, and seven migrated stents. While most ureteral stent malfunctions are routinely managed with retrograde techniques, the percutaneous approach allows effective clinical management in selected cases in which extensive renal stone material or brittle intrarenal stent fragments are present or when previous surgery or ureteral strictures do not permit a retrograde approach. Fluoroscopically guided removal of migrated stents and percutaneous endoscopic techniques, for complex cases such as those requiring stone removal, were successful and without complications.     

Scintigraphic detection of vascular and urological complications in the transplanted kidney: 133 cases

A total of 133 consecutive kidneys, grafted during the past 2 years, were followed by scintigraphy. Patterns of prerenal, renal, and postrenal complications were recognized. Vascular thrombosis diagnosed by photodeficiency of the transplanted kidney was diagnosed and confirmed in 10 patients. Fourteen patients having postrenal urological complications (12 leaks and 2 ureteral obstructions) were all recognized in the late phase of the scintigraphic study. The differentiation between the known parenchymatous causes of anuria was less satisfactory. As a whole, all cases were recognized in which the complication was due to causes that required surgical intervention.     

The role of interventional radiology in the management of kidney transplant complications

PURPOSE: To evaluate the role and the effectiveness of interventional radiology in the treatment of renal transplant complications. MATERIALS AND METHODS: From 1996 to 2004 a total of 288 kidney transplants from cadavers were performed in our Institute. The kidney was always collocated in iliac fossa by creating a vascular anastomosis with the external iliac artery and vein; in all cases the ureter was implanted into the recipient bladder. During the follow-up, 34 complications were observed. Twenty-seven complications in 25 patients (20 males and 5 females; age 35-65 years) were treated by a radiologic procedure: 9 renal artery stenosis and 1 native external iliac artery stenosis (by PTA), 5 ureteral obstructions (by nephrostomy and ureteral stenting), 8 ureteral leaks (by nephrostomy, in 2 cases associated to ureteral stenting) and 4 limphoceles (by percutaneous ultrasound-guided catheter drainage). RESULTS: Primary technical success was obtained in 20/27 cases (74%). Success was obtained with a second interventional procedure in 3/27 cases, 2 limphoceles and 1 ureteral fistula (secondary technical success: 85.2%), with a clinical final success in 23/27 cases (85.2%). We observed a peri-procedural complication rate of 3.7% (1 renal artery post-PTA dissection during a restenosis treatment). Four cases (1 renal arterial post-PTA dissection, 1 ureteral obstruction, 1 ureteral leak and 1 limphocele) needed a surgical correction (14.8%). CONCLUSIONS: Interventional radiology is the first therapeutic approach to treat renal transplant complications. It shows good technical and clinical results and a low complication rate. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective.     

Fluoroscopically guided percutaneous extraction of upper urinary tract calculi

Recent developments in instrumentation have revolutionized the management of renal and ureteral calculi, so that over 90 per cent of all upper urinary tract calculi can presently be treated by means of percutaneous manipulations. Approximately two thirds of these stones can be extracted under either fluoroscopic or nephroscopic control, with the remainder disintegrated under nephroscopic control with ultrasonic or electrohydraulic energies. The authors describe techniques and equipment for fluoroscopically guided percutaneous extraction of renal and ureteral calculi.     

Percutaneous radiofrequency ablation of renal cell carcinoma

Conventional curative therapy for renal cell carcinoma has been open nephrectomy. However, several less invasive and/or nephron-sparing procedures have been developed as alternatives in selected patients. The newest of these therapeutic modalities involves percutaneous image-guided ablation with straight or expandable needle applicators that deposit energy. Radiofrequency ablation is the modality for which there is the largest reported experience with percutaneous application, and involves the use of electrical current to generate frictional heating of tissue. Animal studies confirm the ability of radiofrequency ablation to cause regions of necrosis within normal kidney and in VX2 tumors. Clinically, radiofrequency ablation of small renal cell carcinoma is increasingly being performed in selected patients who are not ideal surgical candidates. Results are excellent for small exophytic tumors, but successful treatment is less likely as tumor size increases or the location becomes more central. Complete treatment of most tumors requires one or more overlapping ablations with the needle electrodes positioned so as to cause necrosis in the entire volume of tumor. The number of overlapping ablations and the position of the needle electrodes vary based on tumor size and geometry. For very large tumors, pre-ablation catheter embolization may enhance the results of ablation by decreasing blood flow and perfusion mediated cooling. Following ablation, imaging with CT or MR is performed to assess the result and to diagnose any residual tumor so that it can be treated. Because the tumor remains in situ, imaging follow-up continues indefinitely. The complication rate of radiofrequency ablation is favorable when compared to surgical techniques. Long-term survival data are not yet available.     

Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.     

Cystic renal tumors: US and CT findings

Cystic renal tumors represent a variety of lesions in which both solid and liquid components coexist. These lesions may be either benign or malignant and include the multilocular cystic nephroma (MCN), the renal cell carcinoma (RCC), and the papillary adenocarcinoma (PAC). The MCN is a rare neoplasm formed of multiple loculated cystic masses divided by septa. The tumor is benign, although there are some rare reports of malignant cases. The RCC and the PAC may appear with cystic patterns. This is rather uncommon for the RCC, which inside has a unilocular or multilocular cystic appearance, if the necrotic component is large. PAC is an infrequent renal tumor, which has a greater tendency to appear as a large mass with a unilocular large cystic space. The ultrasonography (US) and computed tomographic (CT) features of 27 cystic tumors are presented. Both US and CT allowed the recognition of the cystic components, the septa, and the vegetations. The two imaging techniques made it possible to distinguish the tumors into “unilocular” and “multilocular” masses: the former correspond to RCC and PAC, the latter to MCN and RCC. CT added some information on calcified or partially calcified tumors. CT more than US enabled the differentiation between the malignant RCC and the benign MCN for which conservative surgery may be indicated. The two techniques did not allow the differentiation between RCC and PAC, which has different prognostic behavior.     

经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石

 目的 探讨经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石的可行性和应用效果。方法 56例均为肾复杂性结石合并同侧输尿管结石肾积水。先取截石位,经尿道置入输尿管镜到达输尿管结石部位,插入钬激光光纤直视下行钬激光碎石术,然后置入F5输尿管导管至肾盂,退出输尿管镜保留输尿管导管,膀胱内置入导尿管。然后取俯卧位,在B超定位下穿刺,根据结石情况行经皮肾镜碎石术,碎石设备为第四代气压弹道超声清石系统。碎石完成后,通过经皮肾镜置入F6双J管,如有结石下移至输尿管或置入双J管不顺利,可再次通过截石位,经尿道置入输尿管镜行钬激光碎石或放置双J管。结果 56例均成功,无中转开放手术,无一例出现输尿管损伤或结肠损伤,所有输尿管结石均一期清除干净,56例有48例肾脏结石清除干净,结石一期清除率为78.6%（44/56）,二期结石清除率为80.0%（8/10）,结石总清除率为92.8%（52/56）。结论 对于复杂性肾结石合并同侧输尿管结石,术前无须行体外冲击波碎石术。采取经尿道输尿管镜联合经皮肾镜碎石治疗,可同时取出输尿管全程和肾内的结石,结石清除率高,是处理复杂性上尿路结石安全、可靠实用的方法。     

64层容积CT尿路造影对输尿管梗阻性病变的诊断价值

目的:探讨64层容积CT对输尿管梗阻性病变的临床诊断价值.方法:25例输尿管梗阻性病变患者,均行64层容积CT尿路造影(VCTU)检查.对所获容积数据进行三维重组处理,输尿管重组方法有:最大密度投影、多平面重组、容积再现和曲面重组.结果:25 例病变中,输尿管结石15 例,输尿管癌5例,肾输尿管结核2例,双肾及输尿管畸形1例,先天性巨输尿管畸形1例,输尿管炎性狭窄1例.所有病例均经手术或临床资料证实.VCTU能清楚显示其位置、大小、形态及输尿管梗阻扩张情况.结论:VCTU重组图像清晰,对泌尿系肿瘤、结石或其他尿路梗阻性疾病有着独特的临床应用价值.     

输尿管镜下钬激光治疗上尿路疾病293例

目的探讨输尿管镜下钬激光治疗上尿路疾病的方法与疗效。方法中下段输尿管结石及输尿管狭窄经尿道逆行输尿管镜下钬激光治疗;上段输尿管结石、肾结石及输尿管狭窄经皮肾穿刺建立工作通道后,顺行输尿管镜下钬激光治疗。结果输尿管结石单次碎石成功率为92.6%（150/162）,肾结石碎石成功率为93.8%（61/65）。52例输尿管狭窄中,35例狭窄段消失;10例较治疗前狭窄处管腔增宽;4例狭窄段无变化;3例较治疗前狭窄加重输尿管扩张或肾积水加重,患者临床症状无明显改善,行Ⅱ期输尿管狭窄段切除、端端吻合或离断式肾盂输尿管成型术,术后无输尿管狭窄。单纯输尿管息肉14例均一次治愈。发生并发症9例。结论输尿管镜下钬激光治疗上尿路疾病安全、微创、有效、并发症少。     

白肾征X线成像机理探讨

目的　探讨白肾征的形成机理与病因。方法　回顾性分析 2 0例白肾的临床资料及X线表现。结果　在静脉肾盂造影片上 ,患肾实质密度逐渐增高 ,肾盂肾盏呈空虚负影或有少量造影剂充盈。 2 0例中 ,输尿管阳性结石 16例 ,输尿管阴性结石 2例 ,腹膜后转移瘤 1例 ,盆腹部放疗后引起 1例。 7例结石排出后 ,1周内复查IVP ,患肾功能恢复正常 ,白肾征消失。结论　白肾出现提示输尿管发生急性梗阻 ,而患肾功能尚未明显受损 ,及时解除梗阻 ,可免患肾功能受到进一步损害。     

MSCTU对泌尿系统先天性疾病的诊断价值

目的:探讨多层螺旋CT尿路造影及图像后处理技术对泌尿系先天性疾病的诊断价值。材料和方法:对28例经手术证实或临床证实的泌尿系先天性疾病患者行MSCT平扫、肾实质期扫描(延迟80s)及延迟扫描,将原始资料送至工作站进行最大密度投影(MIP)、多平面重建(MPR)、表面遮盖法重建(SSD)和容积重建(VR),获得完整的尿路造影。结果:28例中,输尿管瓣膜症7例,肾盂、输尿管重复畸形6例,输尿管囊肿3例,膀胱憩室2例,肾旋转不良2例,巨输尿管2例,额外肾2例,肾盂憩室1例,输尿管开口异位1例,肾柱肥大1例,迷走血管压迫输尿管1例。结论:多层螺旋CT尿路造影适用于泌尿系先天性疾病的患者,它具有超高速、大范围和薄层扫描的优点,可作为临床诊断的一种有效的辅助检查手段。     

Significant renal hemorrhage following extracorporeal shock wave lithotripsy: imaging and clinical features

Extracorporeal shock wave lithotripsy (ESWL), either alone or in combination with percutaneous or retrograde techniques, has rapidly become the procedure of choice for the treatment of intrarenal and upper ureteral calculi. Complications have been few so far and usually have been urinary obstructions or hemorrhages. Most fluid collections observed after ESWL are asymptomatic and their detection usually does not prolong hospitalization or alter therapy. In five patients out of 2,149 patient treatments symptomatic renal hematomas developed within a few hours after ESWL for renal calculi. In two of these patients the partial thromboplastin time was mildly prolonged. In four patients blood volume replacement was required to treat a falling hematocrit reading or hypotension. Diagnosis of the hematomas was initially made with sonography, although computed tomography and magnetic resonance imaging were used to further define the distribution and extent of retroperitoneal hematomas. Severe ipsilateral flank pain and rapid decrease in the hematocrit reading after ESWL strongly suggest significant bleeding from the treated kidney and require prompt radiologic confirmation and careful clinical treatment until there is evidence that the hemorrhage has stopped.     

Ultrasound evaluation of uncommon renal transplant complications

Twenty-five patients who had undergone renal transplants developed uncommon complications that were detected and followed serially with sonography. Two patients developed renal calculi, which produced hydronephrosis in both instances. Other uncommon causes of postoperative hydronephrosis occurred in 5 cases; the causes included ureteral necrosis, ureteral stricture, and a renocutaneous fistula. Eight cases of renal infarction, manifesting 3 different sonographic appearances, were encountered. The presence and disappearance of postoperative gas in the collecting system were documented in 3 patients. The other unusual abnormalities detected involving the transplanted kidney include tuberculosis, pyonephrosis, 3 solitary cysts, a corpus lutem cyst simulating a perinephric fluid collection, and massive urinary ascites.     

肾脏孤立性纤维瘤影像诊断

目的:探讨肾脏孤立性纤维瘤的病理及影像学表现,提高对少见肾脏肿瘤的诊断与鉴别诊断.方法:回顾手术病理证实的2例肾孤立性纤维瘤影像学和病理学表现.结果:2例肾肿瘤均起自肾实质并突入肾盂,大小分别为2cm和3cm;在CT平扫时均表现为略高密度软组织肿块,边缘清楚锐利,增强后有轻中度强化.其中1例行MRI检查,T2WI上肿块与肾实质比为明显低信号.病理学表现:境界清、质硬的肿块,切面灰白或黄白色有漩涡和编织状结构,形态类似子宫的平滑肌瘤.显微镜下孤立性纤维瘤可见成纤维细胞样细胞交错缠绕在一起伴大量的胶原纤维沉积,成蟹足样.免疫组织化学CD34强阳性.结论:肾孤立性纤维瘤罕见,其由于纤维组织致密造成CT上肿瘤密度较肾实质高,在MRI的T2WI上肿瘤为低信号表现,有助其诊断与鉴别诊断.     

移植肾输尿管梗阻11例分析

目的　总结移植肾输尿管梗阻的防治经验。方法　对 1994— 2 0 0 3年 ,完成的 198例同种异体肾移植术后出现的 11例输尿管梗阻进行回顾分析。结果　 5 4例移植肾输尿管内放置双J管 ,只有 1例出现慢性输尿管远端狭窄 ,发生率 1.85 %,其余 14 4例中有 10例出现梗阻 ,发生率 6.94%。 5例急性梗阻患者均没有放置双J管 ,2例因髂窝血肿压迫者行血肿清除术 ;2例漏尿造成炎性水肿所致 ,行输尿管再植 ;1例结石者经解痉、中成药排石等非手术处理 ,结石排出。 6例慢性梗阻患者中 5例没有放置双J管 ,4例输尿管远端狭窄 ,行输尿管再植术 ;2例输尿管中、远段狭窄 ,行自身输尿管与移植肾肾盂吻合术。结论　 ( 1)放置双J管可以有效预防输尿管梗阻的发生 ;( 2 )移植肾输尿管梗阻经及时恰当的外科处理 ,疗效满意 ,对慢性梗阻患者 ,应根据术中输尿管探查情况 ,选用输尿管再植术或自身输尿管与移植肾肾盂吻合术     

肾、输尿管结核的临床和CTU表现

目的探讨肾、输尿管结核的临床和CT尿路造影（CTU）表现。方法回顾性分析23例肾、输尿管结核患者的临床资料及CTU检查资料。结果23例中,6例仅肾脏受累;11例肾脏、榆尿管同时受累,其中4例伴有膀胱受累;6例仅输尿管、膀胱受累,肾脏未见明显病变;11例伴有肾周受累。结论CTU能准确显示肾、输尿管病变本身及周围受侵犯情况,在肾、输尿管结核患者中具有重要诊断价值。