磁共振尿路成像在小儿原发性肾积水诊断中的作用

目的探讨磁共振尿路成像(MRU)对原发性肾积水的诊断价值。方法对34例上尿路梗阻患儿行MRU检查证实为原发性肾积水,并分别与术后结果对照。结果MRU影像术前均明确为原发性肾积水,显示狭窄段的长度与手术结果一致,对原发性肾积水的定位、定性诊断正确率100%。结论MRU无创、诊断率高,是诊断原发性肾积水的理想方法。     

超声检查在胎儿先天性肾积水诊断中的价值

2002年5月至2005年7月,我们对1523例孕周32、36、38周孕妇行胎儿肾脏超声检查,探讨超声检查在产前肾积水中的诊断标准及价值。现报告如下。对象与方法1523例孕妇,年龄22～38岁,平均27岁。初产妇925例,经产妇598例,均健康无合并症。     

超声诊断胎儿肾积水20例分析

目的探讨超声方法检测胎儿肾积水出生前后的病理、生理演化过程。方法选择2008～2009年在笔者所在医院定期做产前检查和住院分娩的孕妇,应用超声检查筛选并随访肾积水胎儿20例,首次检查发现肾积水后每周复查1次B超,临产前及胎儿出生排尿后各复查1次,对出生后仍有肾积水的婴儿,每1个月复查1次。最长观察时间为1年。结果本组20例孕妇21只肾脏,其中16例17只肾脏肾盂肾盏扩张,经随访最晚至出生后7个月肾积水征象全部消失。3例患者3只肾脏呈重度积水,为不可复性肾积水,经手术证实为泌尿系统先天发育异常。结论大部分胎儿肾积水在随访观察过程中积水变化较轻直至消失,可完全恢复,预后良好。少数重度肾积水出现加重情况,预后差,需采取紧急措施。     

胎儿肾积水的超声诊断及转归分析

目的用超声方法检测胎儿肾积水程度与出生后积水肾的转归情况。方法选择2000年9月至2007年6月我院门诊就诊的单胎孕妇，应用超声检查筛选并随访肾积水胎儿163例（221侧）积水胎肾，随访时间最长为2．5年，同期测量15孕周至40孕周正常胎儿肾脏，记录肾脏集合系统内径及肾皮质厚度。结果正常胎儿的肾脏在孕28—32周可以测量到7mm左右集合系统的分离，肾脏皮质厚度均在5mm以上；本组胎肾集合系统前后径分离值10～15mm者：Ⅰ组，165侧，其中皮质厚度在5mm以下者37侧，6侧手术治疗；集合系统前后径〉15mm者：Ⅱ组，56侧，皮质厚度〉5mm的42侧中3侧手术治疗，皮质厚度5mm以下14侧，其中11例手术治疗。结论产前胎儿肾积水大部分都是生理性的，可随着个体的发育而自发消退，对于生后仍存在肾积水的患儿，应定期随访观察；超声检查显示肾集合系统前后径〉15mm，肾皮质厚度〈5mm的胎儿肾积水往往存在病理性梗阻，应高度重视。     

肾折叠成形术在重度肾积水治疗中的应用

目的 恢复积水肾的解剖和功能。方法 对32例重度肾积水病人,在去除梗阻病因的同时,实施肾折叠成形术。结果 随访3月－3年,肾积水 消失或显减轻。患肾均出现不同程度显影。结论 对估价尚有功能的 积水肾,行肾折叠分层内翻,缩小肾内腔,形成肾盂肾盏雏形,可提高尿液排空能力,促进肾解剖和功能恢复。     

产前超声联合MRI诊断胎儿先天性食管闭锁

目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均0.05),S/D、AFI均高于对照组(P均0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。     

胎儿脑肿瘤的产前MRI诊断:附2例报告

病例1,女,31岁,孕39周,妊娠早中期超声筛查未见胎儿异常(常规超声畸形筛查阴性)。孕38周常规超声发现胎儿右侧大脑4.2 cm×2.9 cm异常回声,内部及周边均见血流信号,周围有无回声区;右侧脑室扩张;诊断为胎儿右侧大脑肿块,性质待定。于孕38+4周行MR检查,T2WI显示胎儿右侧丘脑及顶叶区卵球状4.5 cm×2.5 cm×3.6 cm等信号肿物(图1),内见斑片状低信号;右侧脑室扩张;诊断:胶质瘤,右侧脑室积水。后于外院引产娩出男婴,尸检后病理诊断:星形细胞胶质瘤。     

腹腔镜在巨大肾积水保肾手术中的应用

目的 探讨腹腔镜在巨大肾积水保肾手术中的应用价值和初步临床经验.方法 本组6例.男2例,女4例.年龄15～57岁,平均28岁.5例因腰部胀痛不适及腹部肿块就诊,1例妊娠4个月者于体检B超发现.其中先天性肾盂输尿管连接部（UPJ）梗阻3例,UPJ梗阻继发肾下盏多发结石2例,肾盂结石伴息肉形成1例.6例均合并巨大肾积水,左侧4例,右侧2例;肾积水量2250～8300 ml,IVU均不显影.采用经腹腔途径腹腔镜施行解除肾盂出口梗阻、肾盂成形、肾裁剪及肾折叠固定术.结果 6例手术均获成功,手术时间2.5～5.0 h,出血量50～150 ml,术后平均住院时间7.2 d.术后3个月复查腹部B超：肾积水明显减轻者5例,肾窦分离为1.8、2.0、2.5、2.5、2.8cm,肾脏外形较正常略小者1例.术后3个月行IVU检查均出现不同程度显影.随访3个月～2年,逆行肾盂造影未发现肾盂输尿管吻合口明显狭窄.结论 巨大肾积水保肾治疗采用腹腔镜技术有效、可行.     

MRI在高位复杂性肛瘘诊断中的应用

为探讨相控阵线圈高分辨MRI对高位复杂性肛瘘的术前诊断价值．将35例高位复杂性肛瘘患者术前利用相控阵线圈高分辨MRI扫描,以手术结果为标准．将MRI检查结果及术前临床一般检查结果与手术结果进行比较。结果显示．与手术探查结果相比,术前MRI在诊断肛瘘侵犯位置高低方面的准确率为88．6％,术前一般检查的准确率为57．1％：术前MRI在肛瘘内口诊断方面的准确率为85．7％,术前一般检查的准确率为51.4％。肛瘘的MRI检查结果优于术前一般检查。结果表明,应用相控阵线圈高分辨MRI检查,能较准确地判断肛瘘侵犯部位的高低以及内口的位置、瘘管的走向．对提高手术的成功率及手术时避免肛门括约肌的损伤具有重要指导意义。     

MRI在血管球瘤诊断中的应用

目的 探讨MRI作为诊断血管球瘤的常规辅助检查的必要性.方法 2013年11月至2014年7月收治7例手部血管球瘤患者,均有典型临床症状,术前行X线片检查和(或)MRI检查,手术切除肿瘤且术后病理均确诊为血管球瘤.对病例术前检查进行分析,并检索PubMed数据库进行文献回顾性研究.结果 7例患者中,2例术前只行X线片检查,未发现病灶;3例行X线片和MRI检查,X线片均未显示明显异常,而MRI于T1、T2加权像上提示血管球瘤特征,注入钆对比剂后,病灶明显强化;2例只行MRI检查,显示血管球瘤MRI影像特征.结论 对于有典型临床症状的血管球瘤患者,MRI是一项非常有意义的辅助检查,且应作为常规检查以提高血管球瘤的诊断率.     

Diagnosis of fetal hydronephrosis in utero using ultrasound

Detection of fetal hydronephrosis in utero, subsequent investigation, and surgical treatment is described. With the increasing use of ultrasound for obstetrical problems and greater experience with fetal sonography, more urologic abnormalities will be diagnosed prenatally.     

Management of fetal hydronephrosis

Prenatally detected hydronephrosis has become a common diagnosis for both pediatric nephrologists and urologists. Hydronephrosis is most commonly assessed by the Society for Fetal Urology grading system or anterior–posterior diameter of the renal pelvis in the transverse plane. Some cases of bilateral obstruction, most commonly from posterior urethral valves, can be life-threatening and require close monitoring or, occasionally, fetal intervention. The majority are unilateral and of no threat to the growing fetus. The crux of postnatal management is the separation of the minority of patients whose renal function is at risk from the majority who will suffer no renal consequences. This management involves a regimen of ultrasounds, voiding cystourethrograms, and nuclear renograms for diagnosis and surveillance. Recent literature has been aimed at the timing and necessity of these studies in order to minimize extraneous studies without compromising renal function.     

Diagnosis of bilateral hydronephrosis in utero by ultrasonography

A case is reported of bilateral hydronephrosis secondary to ureteropelvic junction obstruction, diagnosed at thirty-six weeks of gestation when ultrasound was performed on the mother for polyhydramnios.     

腹膜后纤维化致肾积水的诊治(附8例报告)

目的：探讨腹膜后纤维化（RPF）致肾积水的诊断与治疗方法，以提高本病的早期诊治率。方法：通过影像学检查进行诊断和鉴别诊断，根据情况选择保守治疗或手术治疗。结果：保守治疗可延缓或阻止病变发展，手术治疗可明显改善症状，挽救肾功能。结论：对B超检出的肾积水患者，特别是伴输尿管上段积水者，要考虑到RPF，需进一步行静脉肾盂造影检查，CT及MRI对病变范围、程度以及多结构受累比较准确。早期病变以保守治疗为主，中晚期病变以手术治疗为主。     

Incidental fetal hydronephrosis: clinical implication

Maternal ultrasonography performed after twenty weeks of gestation is able accurately to identify and diagnose fetal hydronephrosis. We believe this finding should serve to alert the obstetrician as well as the pediatrician to potential complications which may arise at the time of delivery or immediately thereafter. Urologic evaluation and definitive surgical repair may then be performed when indicated.     

Natural history of fetal and neonatal hydronephrosis

Since pyelocalicectasis alone is common in fetuses, we reviewed reports of fetal hydronephrosis that resolved spontaneously or at birth. Severe fetal hydronephrosis with calicectasis or parenchymal thinning rarely resolves spontaneously before or after birth. We also reviewed the clinical and experimental literature on renal hypertrophy. After unilateral nephrectomy in neonatal animals or after birth with congenital absence of one kidney in humans, the remaining kidney hypertrophies very quickly. In infants and young animals, the eventual size of the remaining kidney is inversely proportional to the age at which one kidney is lost. This improvement in residual renal function seen after renal loss in infancy, compared with older children, itself constitutes a strong argument for early relief of obstruction. If contralateral renal hypertrophy has occurred, the treated damaged kidney may resume growth in parallel with its hypertrophied mate but does not become as large or recover normal potential for growth. In other words, if correction of a unilateral obstruction is deferred until contralateral hypertrophy occurs, the obstructed kidney then has less potential for recovery of function.