腔静脉后输尿管影像学表现

腔静脉后输尿管又叫环腔静脉输尿管,是一种较少见,可以引起肾盂积水及相关症状的先天性畸形。本文回顾性分析了经静脉尿路造影(IVU)、逆行静脉肾盂造影(RP)及CT检查诊断的腔静脉后输尿管5例,对其临床特点和影像学表现加以分析,旨在探讨影像学在腔静脉后输尿管诊断     

下腔静脉后输尿管的诊断与治疗

目的 总结下腔静脉后输尿管的诊断与治疗方法.方法 对7例下腔静脉后输尿管临床资料进行回顾分析.结果 7例患者术前均明确诊断,采用输尿管切断复位矫正术治疗,术中切断下腔静脉后有病变的输尿管2～3 cm,无张力吻合输尿管.术后随访6个月至10年,所有患者症状消失,肾积水明显减轻.结论 下腔静脉后输尿管诊断主要依据多种影像学的协同检查,静脉肾盂造影(IVU)和逆行输尿管肾盂造影是主要的诊断方法,狭窄段切除,输尿管复位成形术效果良好.     

下腔静脉后输尿管的影像学诊断7例

目的分析下腔静脉后输尿管的影像检查表现,提高对其诊断水平。方法对经过手术治疗的7例下腔静脉后输尿管的患者,对其手术前静脉尿路造影(IVU)、逆行肾盂造影(RP)检查的表现进行分析。结果下腔静脉后输尿管影像检查特征性表现为患侧肾盂肾盏扩张,输尿管上段扩张移位,输尿管走行呈"S"状或反"J"状。结论IVU、RP是诊断下腔静脉后输尿管的主要方法。     

5例下腔静脉后输尿管的诊治体会

目的:探讨下腔静脉后输尿管的治疗体会。方法:运用B超、静脉尿路造影(IVU)、逆行肾盂输尿管造影(RU)或MRI等检查,明确诊断。治疗采用输尿管切断,于下腔静脉前外侧复位矫正术。结果:术前对5例患者的诊断明确,均采用矫正复位术治疗,手术后3⁶个月进行复查,原先症状未见,肾积水及输尿管上段的扩张和积水均显著减弱,输尿管保持通畅,吻合口也未见狭窄。结论:下腔静脉后输尿管诊断主要依靠IVU和RU,输尿管切断复位矫正术是治疗的主要方法。     

下腔静脉后输尿管的影像诊断价值

目的评价影像学检查在下腔静脉后输尿管的诊断价值。方法对7例下腔静脉后输尿管的B超、静脉尿路造影(IVU)、逆行尿路造影(RGU)及CT、MR成像的影像资料进行回顾性分析和比较。结果 B超检查7例显示右侧输尿管上段并右肾积水;IVU检查7例可见输尿管上段呈反"J"征,移行段以上输尿管及肾盂、肾盏不同程度扩张积水;RGU检查7例所见移行段以上之输尿管及肾盂、肾盏表现与IVU检查所见相似,患侧输尿管全程显影;CT扫描2例显示右侧输尿管在腰3~4平面水平于腔静脉的后侧及内外侧显影;MR检查1例显示输尿管于下腔静脉外后绕至下腔静脉内前侧。7例均于术前获得明确诊断并进行了手术,证实为右侧下腔静脉后输尿管。结论多种影像学的协同检查为下腔静脉后输尿管的诊断提供了主要依据,是诊断下腔静脉后输尿管的可靠方法。     

腔静脉后输尿管的诊断与治疗

目的 :探讨腔静脉后输尿管的诊断及治疗。方法 :对 7例腔静脉后输尿管的诊断及治疗进行了分析。右肾积水经B超、IUP、RGP筛选 ,腔静脉后输尿管多可确诊 ,对不能诊断者CT联合逆行尿路造影可明确诊断。 2例因肾无功能行肾切除术 ,5例行输尿管成形术。结果 :1例术后吻合口狭窄 ,再次手术后治愈。随访 6～ 36个月 ,除 2例轻度输尿管肾盂积水外 ,其余正常。结论 :一经确诊腔静脉后输尿管 ,应积极手术治疗     

CT诊断下腔静脉后输尿管

目的 评价CT检查在下腔静脉后输尿管诊断中的价值。方法 10例下腔静脉后输尿管患者作CT检查，并对分析CT与B超、静脉尿路造影（IVU）和逆行尿路造影（RU）等检查在下腔静脉后输尿管诊断中的价值。结果 根据CT图像显示输尿管与下腔静脉的位置关系改变，10例患者术前均获确诊。结论 CT诊断技术在下腔静脉后输尿管中的应用，可使患者免于以往的浸入性检查，为手术治疗提供可靠的影像学依据。     

腔静脉后输尿管的诊断与治疗

目的：探讨腔静脉后输尿管的诊断及治疗。方法：对７例腔静脉后输尿管的诊断及治疗进行了分析。右肾积水经Ｂ超、ＩＵＰ、ＲＧＰ筛选,腔静脉后输尿管多可确诊,对不能诊断者ＣＴ联合逆行尿路造影可明确诊断。２例因肾无功能行肾切除术,５例行输尿管成形术。结果：１例术后吻合口狭窄,再次手术后治愈。随访６～３６个月,除２例轻度输尿管肾盂积水外,其余正常。结论：一经确诊腔静脉后输尿管,应积极手术治疗。     

泌尿系造影诊断下腔静脉后输尿管

目的提高下腔静脉后输尿管病的诊治水平。方法回顾性分析7例经手术证实的下腔静脉后输尿管,诊断主要依据静脉尿路造影（IVU）、逆行尿路造影（RP）、B超及CT检查。结果经IVU、RP、B超及CT检查,所有病例在术前均获得明确诊断;IVU显示5例上段输尿管扩张呈典型的反“J”状,2例呈“锥形”改变;RP显示输尿管导管呈“S”形;CT扫描显示下腔静脉与腹主动脉问圆点状输尿管充盈影。结论泌尿系造影检查是诊断下腔静脉后输尿管的可靠方法。     

下腔静脉后输尿管的诊断与治疗

目的 提高下腔静脉后输尿管的诊治效果.方法 回顾分析我院收治的15例下腔静脉后输尿管的诊治资料.主要临床表现有腰背部不适、尿路感染等.影像学检查(包括腹部B超、IVU、逆行造影及CT)发现右肾积水、输尿管上段扩张和走行异常.10例行肾孟离断、输尿管复位、肾盂成形术;3例行右肾切除术;2例行输尿管端端吻合术.结果 对12例矫形术后患者随访,右肾积水不同程度减轻,肾功能正常,吻合口无狭窄,临床症状完全消失.结论 影像学检查有助于明确下腔静脉后输尿管的诊断,手术治疗可纠正这种先天性畸形,有助于肾功能的长期改善.     

经胸超声指导下腔静脉边缘不足房间隔缺损介入封堵术的研究

目的评价经胸超声心动图（TTE）指导继发孔型房间隔缺损（ASD）下腔静脉边缘不足患者介入封堵术的效果及可行性。方法下腔静脉边缘5mmASD患者（下腔组）14例,术前用TTE仔细筛查,封堵术中TTE监测封堵过程、封堵器的牢固性,彩色多普勒超声观察有无残余分流;同期中央型ASD患者69例行封堵术（中央组）。术后随访6个月。结果全部病例均封堵成功。下腔组ASD最大径为（23±8）mm,选用封堵器型号（29±10）mm;中央组术前缺损最大径（20±10）mm,应用封堵器型号（24±11）mm,下腔组大于中央组（P〈0．05）。术后即刻下腔组12例（85．7％）完全封堵,中央组全部完全封堵（100％）,2组比较差异有统计学意义（P〈0．05）。术后6个月随访2组患者均完全封堵,无残余分流。结论 TTE是指导继发孔型ASD下腔静脉边缘不足患者介入封堵术的可行、有效方法。     

Neonatal hydronephrosis detected on routine health check-up

BACKGROUND/PURPOSE: Prenatal dilatation of the urinary tract may be caused by obstructive defects, and it is known that 20% of normal fetuses have some degree of renal pelvic or calyceal dilatation, determined by sonographic examination. We analyzed the clinical course of patients found to have dilatation of the renal pelvis by ultrasound 1 month after birth, and compared prenatal and postnatal sonograms of each patient. METHODS: Between January 1996 and December 1998, renal ultrasounds were performed on 2,071 children at their 1 month routine health checks in our hospital. We found dilatation of the renal pelvis in 92 kidneys in 84 children and then compared these neonatal sonograms with the prenatal ultrasounds for each child. Ultrasound examinations were performed at 28 weeks of gestational age and 1 month after birth. Our criterion for diagnosis of hydronephrosis at 1 month of age was a renal pelvis measuring greater than 7 mm at the central echo complex. The medical records of patients found to have hydronephrosis were then reviewed. RESULTS: Eight patients had bilateral hydronephrosis, 2 had dilatation only in the right kidney and 74 had this finding only in the left kidney. Examination of 36 (39%) of these 92 kidneys revealed renal pelvic dilatation to be present both prenatally and neonatally. The dilatation ranged from 7 to 43 mm. No dilatation of the renal pelvis was seen on the other 56 fetal examinations. During the follow-up period, 2 patients (1 with bilateral and the other with right-sided hydronephrosis) were diagnosed with vesicoureteral reflux, the 1 patient with bilateral pelvic dilatation was found to have a vesico-ureteral junction obstruction. After full evaluation, the other children were found to have no anatomic abnormalities. CONCLUSIONS: We found 84 of 2,071 children showed dilatation of the renal pelvis on ultrasound examination performed at 1 month of age. Three (3.3%) of the 84 children required surgery to correct the neonatal hydronephrosis detected via this imaging modality. Interestingly, 88% of the children had only left-sided hydronephrosis, which did not predict an adverse outcome during the follow-up period. We conclude that neonatal hydronephrosis appears to be a relatively benign condition and the requirement of surgery is relatively slight.     

妇产科手术泌尿系统损伤原因与对策

目的探讨妇产科手术中泌尿系统损伤的易发因素及其治疗方法。方法对妇产科手术中泌尿系统损伤20例病例进行回顾性分析。结果妇产科手术所致泌尿系统损伤以广泛性全子宫切除、剖官产术为常见。输尿管、膀胱损伤是妇产科手术相对常见的严重并发症。结论妇产科手术中泌尿系统损伤是较少见但严重的并发症，术前诊断明确(包括病变性质、范围、与周围脏器组织关系)、熟悉盆腔解剖结构、严格手术操作规范是预防损伤的关键，输尿管插管(内支架)或吻合及膀胱修补是其主要治疗措施。     

肾盂成型并肾折叠固定治疗巨大肾积水临床分析

目的：探讨肾盂成型并肾折叠固定治疗巨大肾积水的疗效。方法：回顾分析2006年1月～2010年1月采用肾盂成型并肾折叠固定治疗巨大肾积水42例的临床资料。结果：本组42例采用肾盂成型并肾折叠固定治疗巨大肾积水患者均切口一期愈合,无感染及尿瘘等并发症发生。术后经随访半年至1年采用B超及静脉肾盂造影进行复查,手术治疗的患肾肾盂容积显著缩小,肾盏无膨出、扩张,吻合引流畅通,无积水发生,肾功能恢复良好。结论：通过肾盂成型并肾折叠固定治疗巨大肾积水,既能够治疗原发疾病,解除泌尿系梗阻,又可最大限度地保留肾脏功能,促进了肾功能的恢复,有利于肾形态及功能的早期恢复,防止了肾盂肾炎的发生及结石的再发。     

Thiabendazole induces urinary tract toxicity in male ICR mice

Male ICR mice were administered thiabendazole (TBZ) in the diet at concentration of 0 (control), 0.8, 1.2 and 1.6% for 44 weeks. The mortality was 10, 6, 40 or 90% in control, 0.8, 1.2 or 1.6% TBZ group, respectively. In dead mice, the gross findings included the abnormalities of kidney such as atrophy, hydronephrosis or swelling in 2, 67, 95 or 96% of the 0, 0.8, 1.2 or 1.6% TBZ group, respectively. In surviving mice at the end of study, the right kidney weight of treated groups was significantly lower than that of control group. The urinary bladder weight of treated groups was significantly higher than that of control group. Gross findings in treated mice included the renal atrophy, hydronephrosis, calculi in renal pelvis or urinary bladder and thickening of the bladder wall. Microscopic findings in the kidneys of treated mice included nephrosis, hydronephrosis and hyperplasia of transitional epithelium of renal pelvis and/or papilla. In the urinary bladder, hyperplasia or squamous metaplasia of transitional epithelium were found in treated mice. Administration of TBZ in the diet for 44 weeks results in nephrosis and calculus formation in the renal pelvis and urinary bladder of male ICR mice, and is associated with hyperplasia of transitional epithelium of renal pelvis or urinary bladder.     

多排螺旋CT及多平面重建(MPR)对输尿管结石诊断价值的研究与分析

目的探讨多排螺旋CT及多平面重建(MPR)对输尿管结石诊断价值,为输尿管结石的诊断提供参考。方法共纳入行尿路平片及静脉尿路造影辅助确诊的80例输尿管结石患者,同时随机抽取90例检查未有输尿管结石的健康人群。纳入研究时所有受试者均行尿路平片及静脉尿路造影辅助进行诊断作为金标准,同时行多排螺旋CT及MPR进行诊断,分析多排螺旋CT及MPR对输尿管结石的诊断价值。结果以尿路平片及静脉尿路造影辅助诊断作为金标准,多排螺旋CT及MPR对输尿管结石的诊断敏感度为91.3%,特异度为88.9%,阳性似然比为88.0%,阴性似然比92.0%。多排螺旋CT及MPR对输尿管结石的分析,结果显示,80例患者中检出73例(91.3%)患者有输尿管结石,其中左侧46例,右侧27例;多发结石8例,单发结石65例;输尿管上段38例,中段13例,下段22例;结石大小0.2².3 cm,平均大小(1.3±0.6)cm;有48例患者输尿管有不同程度的扩张,其中40患者有不同程度的肾积水。结论多排螺旋CT及MPR不仅可以简单、快速的对输尿管结石进行比较高的诊断,且可以更好的对结石的大小、位置等提供信息,值得临床推广应用。     

积水型重复肾伴重复输尿管扩张的超声诊断

目的 为临床提供一种简便、迅速、无损伤的诊断积水型重复肾伴重复输尿管扩张。方法 应用超声常规扫查两肾区．采取多方位、多切面．对11例积水型重复肾伴重复输尿管扩张患进行检查。结果 超声所见与手术或X线造影基本一致。发生于左肾5例,右肾6例;9例位于上肾部,2例位于下肾部;合并结石1例．合并输尿管囊肿3例。结论 总结了6种积水型重复肾伴重复输尿管扩张超声表现形式,凡具备其中表现形式之一即可直接作出积水型重复肾伴重复输尿管扩张的诊断;如能与X线造影相结合,可提高有功能重复肾重重复辅尿管的诊断的准确率。     

植物制剂普适泰对女性顽固下尿路刺激征的疗效观察

目的了解普适泰（舍尼通）对女性下尿路病变患者顽固存在的排尿刺激症状的疗效。方法将60例经抗炎或手术治疗后仍有不同程度排尿刺激症状存在的女性下尿路病变患者随机分为：①A组（30例）：患者接受普适泰片口服治疗；②B组（30例）：患者仅予安慰剂口服作对照组。通过国际下尿路症状（Lower urinary tract symptoms，LUTS）评分和生活质量（Quality of life，QOL）评分变化，比较分析两组疗效。结果治疗4周后，A组LU偈和QOL评分变化均优于B组，差异有统计学意义（P〈0．05）。结论口服普适泰片有助于改善女性患者顽固的下尿路刺激征状。     

回肠代输尿管术治疗孤立肾并输尿管癌1例

目的 总结回肠代输尿管术治疗孤立肾并输尿管癌的经验,为临床工作提供借鉴和指导。方法 分析1例功能性孤立肾合并输尿管癌患者接受回肠代输尿管术治疗的临床资料,结合文献进行分析讨论。结果 术中切除全段右侧输尿管及袖状切除输尿管入口处膀胱壁后切取25 cm 回肠替代右侧输尿管。 术后夹闭肾造瘘管后早期出现轻度肾功能不全,2周后恢复正常。术后出现代谢性酸中毒,积极予以口服碳酸氢钠后得以纠正。术后1个月行右侧上尿路顺行造影示回肠输尿管通畅,各吻合口无狭窄,肾盂轻度扩张。术后随访6个月,患者排尿正常,肾功能正常,一般情况良好。未见肿瘤复发征象。结论 对于孤立肾合并输尿管癌患者回肠代输尿管术是一种可供选择的手术方法,能够去除肿瘤、恢复尿路的连续性、避免永久性肾造瘘、 改善生活质量。     

Moment analysis of drug disposition in kidney. V: In vivo transepithelial transport of p-aminohippurate in rat kidney

A new method that can assess the kinetics of in vivo transepithelial transport in rat kidney has been established. The method is based upon a multiple-indicator dilution experiment and the moment analysis theory. After simultaneous bolus injections of p-aminohippurate (PAH) and inulin into the right renal artery, blood samples were taken from the carotid artery and urine was separately collected from right and left ureters. The characteristic response for the first passage of drugs through the right kidney was evaluated by taking blood circulation into consideration. To determine the mean artery-to-vein transit time and the extraction ratio in the kidney, an intravenous injection was also performed as a reference experiment for deconvolution. The urinary excretion curve corresponding to the first passage was obtained as the difference between both kidneys. The mean artery-to-lumen transit time (mean transepithelial transit time, Tcell) was computed by subtracting the mean urinary transit time of inulin from that of secreted PAH. Since transport across the luminal membrane into the lumen from tubular epithelial cells can influence the cellular residence time of drugs, Tcell and the single-pass mean residence time in epithelial cells (Tcell,sp) can be thought of describing luminal membrane transport. The value of Tcell obtained for 0.1 mM PAH was 22 sec and it was prolonged to 61 sec in the presence of probenecid, suggesting an inhibitory effect on transport across the luminal membrane. On the other hand, antiluminal membrane transport into cells from blood is characterized by the volume of distribution in the kidney (VdPAH). VdPAH was remarkably decreased by treatment with probenecid, indicating an inhibitory effect on antiluminal membrane transport. The effects of probenecid on both sides of epithelial cell membrane transport were first demonstrated in vivo. The present method is useful for the analysis of in vivo transepithelial transport including antiluminal and luminal membrane transport for drugs excreted via tubular secretion.