超声诊断输尿管癌1例

患者男 ,70岁。 4个月前肉眼血尿 ,无明显疼痛 ,外院B超诊断左肾积水 ,左输尿管结石予对症处理后血尿缓解。近2个月内肉眼血尿不停 ,来我院就诊KUB +IVP检查 ,诊断左输尿管下段结石 ,收住院手术。入院后进行肾、输尿管、膀胱超声检查 ,见左肾肾盂分离 35mm ,左输尿管扩张 7mm ,左输尿管下段未见强回声光团 ,但见管腔内充满低回声 ,大小约2 0mm× 13mm(见图 ) ,右肾、右输尿管及膀胱未见异常。超声诊断 :左肾积水、左输尿管扩张、左输尿管下段占位。再行MRI检查 ,诊断提示 :左肾积水、左输尿管扩张及下段结石可疑。再行输尿管镜检查 ,结…     

肾窦分离在急性输尿管结石中的诊断价值

目的 探讨肾窦分离以及腔内超声检查对输尿管结石的诊断价值.方法 在急性腹绞痛伴有或不伴有血尿的急诊患者的超声检查中,对发现肾窦分离的患者,测量两侧肾窦分离的宽径,将有输尿管结石侧肾窦分离情况与无输尿管结石侧肾窦分离情况进行比较,并行输尿管全程扫查;对于膀胱充盈不佳、并排除中上段输尿管结石者,行经直肠(阴道)输尿管下段检...     

二维超声对输尿管结石的诊断价值

输尿管结石是临床常见病、多发病。当结石由肾排人输尿管时，引起输尿管痉挛，患者常出现肾绞痛、血尿、腰部不适等临床症状，少数还伴有恶心、呕吐，输尿管结石还是引起尿路梗阻的主要原因。因此，对输尿管结石的诊断及定位尤为重要。本文对2000年5月～2001年12月间本院门诊、急诊、住院患者6012例超声检查结果中108例输尿管结石进行分析，并与逆行肾盂造影、X线腹平片结果进行对比，探讨二维超声对输尿管结石的诊断价值。     

输尿管镜对肾绞痛的诊断和治疗

目的探讨输尿管镜对肾绞痛患者的有效诊断及治疗方法。方法46例反复发作肾绞痛患者在连续硬脊膜外阻滞麻醉下行输尿管镜检查及治疗,其中KUB及IVP示32例输尿管中下段见结石影,12例未见阳性结石影,但患肾轮廓增大,2例反复发作肾绞痛,未做B超及IVP检查。结果46例患者中,36例见输尿管结石,结石均较疏松,大小0.8～0.4cm,24例用套石篮套出结石,7例行套石篮套石时,结石碎裂成0.2～0.3cm,5例气压弹道碎石后结石碎成0.2cm,自行排出;2例输尿管下段局限性炎症经抗感染治疗治愈;2例肾盂输尿管连接部狭窄,行输尿管镜下小气囊扩张术;4例见输尿管中段或下段黏膜充血水肿,考虑结石曾停留并已排出;1例输尿管息肉行中转开放手术;1例肾内出血经检查诊断为肾内血管畸形,予以高选择性肾动脉栓塞而治愈。结论肾绞痛病因多为结石,但较小或较疏松结石在IVP或B超时难以发现,输尿管狭窄也易致肾绞痛发生,但绞痛相对较轻。对于难以明确诊断的肾绞痛,可以采用输尿管镜进行诊断,同时可以进行治疗,但输尿管镜检术为一种创伤性检查,对于用其他方法无法明确者可试用于检查和治疗,但不宜作为肾绞痛的常规检查方法。     

输尿管先天性狭窄的超声诊断

本组观察6例,男5例,女1例,平均年龄38.1岁。6例均在B超诊断之后进行手术证实。6例先天性输尿管狭窄中肾盂输尿管开口处4例;中上段输尿管狭窄伴尿道狭窄1例;下段输尿管狭窄1例。声象图表现4例一侧单纯性肾盂积水,2例一侧肾盂积水伴狭窄上段输尿管扩张,6例中有2例巨大肾盂积水,患侧肾无功能;输尿管狭窄处光滑,无肿瘤或结石回声。讨论:1.输尿管先天性狭窄并不少见,在我们遇见的病例中,认为B超能够达到诊断目的。B超检查病人无痛苦,能够早期诊断,明确定位,指导外科治疗,     

三大间接征象在输尿管结石急性梗阻中的诊断意义

目的:探讨B超观察肾实质回声、肾周积液、肾盂积水三大间接征象在输尿管结石急性梗阻中诊断意义。方法:应用B超对临床疑肾绞痛58例患者肾实质、肾周及肾盂情况进行了动态观察,了解输尿管结石梗阻部位,而后作一记录,热敏打印图片存档,经碎石及临床排石后复查。结果:58例输尿管结石均有不同程度的肾盂积水占100％;肾实质回声增强51例(51/58)占87％;肾周积液29例(29/58)占50％。肾实质回声增强、肾周积液均在治疗后1～6天消失。结论:肾实质回声增强、肾周积液、肾盂积水在急性输尿管结石梗阻诊断、观察中有重要的意义。     

先天性输尿管狭窄误诊一例报告

患者,男性,8岁。无明显诱因出现左腹阵发性绞痛5天,拟左输尿管结石入院诊治。体查:左肾叩痛,左输尿管中段轻压痛。右肾及输尿管行程未见异常。血、尿常规正常。B超:左输尿管中段结石,左肾积水。 腹平片:泌尿系行程未见阳性结石征。 静脉肾盂造影显示:左肾盂中等度扩大积水,左侧输尿管上端与肾盂交界部位见约0.5×0.7cm可疑结石。右肾及右输尿管未见异常。 手术所见:左肾盂扩张呈囊状,输尿管上段与肾盂外膜粘连,使肾盂输尿管连接都迂曲成角,范围约     

彩色多普勒超声诊断输尿管结石的临床研究

为探讨彩色多普勒超声(CDU)诊断输尿管结石的临床价值。对174例输尿管结石患者行CDU探查。本组输尿管上段结石82/85、中、下段结石24/26与61/63结石周边见五彩镶嵌的尿流信号,其中不伴肾盂积水10例。应用CDU弥补了B超诊断的不足,提高了输尿管结石的检出率。特别对输尿管中、下段结石,不伴肾盂积水的输尿管结石提供了一种新的诊断手段。     

二维超声诊断输尿管结石及临床意义

应用二维超声检查输尿管结石是其诊断方法之一，在泌尿系结石病中，当结石由肾掉入输尿管时，患可伴有肾绞痛、血尿、腰背不适等症状出现，因此，对输尿管结石的诊断及定位尤为重要。本结合实践对其诊断及临床意义进行探讨。     

移植肾输尿管梗阻的超声诊断

目的 提高超声对移植肾输尿管梗阻的诊断水平，对在758例次肾移植患者中经二维超声发现的23例次移植肾输尿管梗阻病例进行总结分析。方法 应用二维超声经腹壁对移植肾及输尿管进行检查，发现肾盂扩张积水者，换用高频探头重点扫查输尿管管壁及管腔，并进行动态观察。结果 三种类型梗阻均有肾肿大和肾盂扩张积水，以狭窄性为最重。其中狭窄性梗阻14例次，结石性梗阻8例次，外压性梗阻1例。结论 二维超声是诊断移植肾输尿管梗阻的首选方法，对结石性和外压性梗阻可明确诊断，对狭窄性梗阻可结合肾图、经皮造瘘管顺行造影来确诊。     

下腔静脉后输尿管的诊治

【目的】总结下腔静脉后输尿管的诊治经验。【方法】对6例下腔静脉后输尿管患者的症状,影像学检查和治疗进行回顾性分析。【结果】6例均有右腰胀痛,2例有发作性血尿,1例继发输尿管结石且伴肾绞痛发作。诊断主要依据IVU及逆行输尿管造影,表现为肾及输尿管上段积水,呈“S”形扩张。6例均行狭窄段切除,输尿管复位成形术。随访8个月至12年,所有患者症状消失,肾积水明显减轻。【结论】对不明原因的右肾及右输尿管上段积水者应考虑到本病可能,IVU及逆行输尿管造影是主要诊断方法,狭窄段切除,输尿管复位成形术效果良好。     

Emergency Ultrasound and Urinalysis in the Evaluation of Flank Pain

Objectives: To determine the sensitivity and specificity of limited emergency ultrasonography of the kidney in diagnosing renal colic. Methods: This was a prospective observational trial from December 2001 to December 2003 at a suburban emergency department. Patients who presented with flank pain suspicious for renal colic were enrolled. Exclusion criteria included fever, trauma, known current kidney stone, unstable vital signs, and inability to provide consent. All patients underwent sequential emergency ultrasonography and computed tomography of the kidneys and bladder. Data were analyzed using chi-square analysis. The primary outcome was the sensitivity and specificity of ultrasonography. Results were also stratified for presence of hematuria. Results: Fifty-eight of the 104 patients enrolled in the study were diagnosed with renal colic. The overall sensitivity and specificity of bedside ultrasonography for the detection of hydronephrosis were 86.8 (95% confidence interval [CI] = 78.8 to 92.3) and 82.4 (95% CI = 74.1 to 88.1), respectively. In patients with hematuria, hydronephrosis by emergency ultrasonography demonstrated a sensitivity and specificity of 87.8 (95% CI = 80.3 to 92.5) and 84.8 (95% CI = 73.7 to 91.9), respectively. In 55 of the cases, the initial computed tomograph was read by a resident and later re-read by an attending physician. Using the reading of the attending physician as the criterion standard resulted in a sensitivity and specificity of 83.3 (95% CI = 73.2 to 88.0) and 92.0 (95% CI = 79.9 to 97.6), respectively. Conclusions: Emergency ultrasonography of the kidneys shows very good sensitivity and specificity for diagnosing renal colic in patients with flank pain and hematuria.     

移植肾输尿管梗阻的超声诊断

目的探讨超声对移植肾输尿管梗阻的诊断价值.方法应用二维超声经腹壁对移植肾输尿管进行检查,发现肾盂扩张积水者,换用高频探头重点扫查输尿管管壁及管腔,并进行动态观察.结果在758例移植肾超声检查中,发现移植肾输尿管梗阻23例.其中狭窄性梗阻14例,结石性梗阻8例,外压性梗阻1例.结论二维超声是诊断移植肾输尿管梗阻的首选方法,对结石性和外压性梗阻可明确诊断,对狭窄性梗阻可结合肾图、经皮造瘘管顺行造影来确诊.     

封堵器联合输尿管镜钬激光碎石与体外震波碎石术的比较

目的比较封堵器联合输尿管镜钬激光碎石与体外震波碎石治疗输尿管上段结石的疗效.方法回顾性分析96例输尿管上段结石患者资料,其中输尿管镜取石术（URL）中应用管路封堵器46例（联合治疗组）,体外震波碎石（ESWL）50例（ESWL组）,比较二种手术方式的结石清除率、手术并发症发生率、住院费用.结果结石清除率联合治疗组97.83%（45/46）,ESWL组82.00%（48/50）,差异有统计学意义（P〈0.05）.总费用联合治疗组（9120±320）元,ESWL组（2158±120）元,差异有统计学意义（P〈0.05）.术后并发症联合治疗组发热3例、肾绞痛2例、血尿均有但不严重,ESWL组发热4例、肾绞痛5例,术后并发症两组差异有统计学意义（P〈0.05）结论输尿管封堵器应用于输尿管镜下钬激光碎石治疗输尿管上段结石安全有效,且操作简单、方便,能有效减少术中结石漂移,提高结石清除率,但费用相对于ESWL高.     

B超与X线对肾积水诊断的比较(附207例报告)

目的:比较B超和X线对肾积水的诊断标准,为临床提供有价值的诊断依据。方法:对经手术和临床确诊的207例尿路梗阻性肾积水病例的B超与X线平片和静脉肾盂造影的特点进行回顾性分析。结果:B超显示肾积水174例,阳性率84.05%;X线显示肾积水91例,阳性率47.39%。结论:B超对少量、轻度肾积水诊断的特异性明显优于X线;对肾绞痛、尿频尿急或伴血尿等临床表现者,如B超检查发现肾窦分离>0.7cm者应随访。     

经输尿管镜钬激光碎石术治疗输尿管结石180例报告

目的探讨经输尿管镜钬激光碎石术治疗输尿管结石的安全性和有效性。方法回顾总结我院自2005年12月至2009年7月间,应用经输尿管镜钬激光碎石术治疗输尿管结石180例（其中男95例,女85例）,输尿管上段结石45例,中下段结石135例,结石直径大小0．5—3．0cm,平均1．2cm。观察手术成功率、手术时间、术后住院时间、并发症等。结果单次碎石成功率95％（171／180）,其中输尿管上段86．7％（39／45）,中下段97．8％（132／135）。未成功的9例中,4例结石上移至肾盂,均为输尿管上段结石,5例因进镜失败中转开放手术。手术时间18—120min,平均43min,术后住院时间1—8d,平均3．5d。并发症发生率4．44％（8／180）,其中输尿管穿孔4例,均为输尿管上段结石,术后持续高烧3例（其中1例同时出现持续血尿）,术后并发肾绞痛并48h无尿1例。结论经输尿管镜钬激光碎石术治疗输尿管结石尤其是输尿管中下段结石安全可靠,具有疗效肯定、损伤小、住院时间短等优点。     

Duplicated or Ectopic Renal Collecting System in Two Adult Emergency Department Patients

BackgroundDuplicated renal collecting system is a urological anomaly often found in pediatric patients. It is less commonly diagnosed in adulthood, particularly in a pregnant patient. Many point-of-care ultrasonography users may not be aware of this diagnosis, particularly in patients in the emergency department. It is important to recognize the duplicated system because in general, patients will often have hydronephrosis in only one renal pole rather than the entire kidney, which corresponds to an unequal renal function as documented on renal nuclear medicine functional scans. As a consequence, if the sonographer only identifies one ureter and incompletely visualizes the kidney, obstruction of one of the duplicated structures may be missed.Case ReportWe report 2 cases of duplicated ureter in patients in the emergency department who present with flank pain and urinary symptoms. Both patients were adult females, one pregnant, with duplicated ureter and severe right upper pole hydroureteronephrosis. The first patient was admitted for intravenous antibiotic therapy for pyelonephritis in pregnancy. The second was discharged with oral antibiotics and urgent urologic follow-up.Why Should an Emergency Physician Be Aware of This?Duplicated ureter should be considered in patients with recurrent urinary tract infections or enuresis. Point-of-care ultrasonography users should note the differential hydronephrosis between upper and lower renal poles and may visualize duplicate or ectopic ureteronephrosis or ureterocele. Patients should be prescribed prophylactic antibiotics and have urgent urologic follow-up because the untreated condition can lead to irreversible renal damage.     

The relationship between the severity of pain and stone size,hydronephrosis and laboratory parameters in renal colic attack

ObjectiveIn this study, we investigated the relationship between the severity of pain level and hydronephrosis, hematuria and pyuria presence in the acute renal colic attack and whether there was a correlation between the stone size and inflammatory markers.MethodsThe patients' pain scores determined by Visual Analog Scale (VAS), CRP, WBC and NLR levels from the laboratory results, hematuria and pyuria presence in the urine analysis and hydronephrosis presence in the imaging methods were recorded. Moreover, stone size was measured for the patients for whom computed tomography (CT) method was applied.ResultsMean age of the 275 patients was 41.0 ± 14.9 and 61.1% of them were male. The patients' mean VAS score was 73.3 ± 16.5.The mean VAS score of the groups of which hematuria and pyuria were positive and which have hydronephrosis finding was statistically higher than those whose were negative.The mean stone size was 5.2 ± 2.1 mm, and those with signs of hydronephrosis on their CT (n = 66) were 5.4 ± 2.3 mm, while those with no signs of hydronephrosis (n = 57) were 4.9 ± 1.7. No statistical difference was found in stone size between patients with hydronephrosis and those without. Not any correlations were determined between the stone size and VAS pain score of the cases.ConclusionsWe detected that the pain level was not correlated with the stone size and big stones were not statistically riskier in the hydronephrosis development. However, we think that the risk of complications such as hydronephrosis is higher in the patients whose pain level are higher and the infection may be accompanied by this group.     

大剂量静脉肾盂造影在输尿管阴性结石体外碎石中的应用

目的：探讨大剂量静脉肾盂造影在输尿管阴性结石体外碎石中的应用效果。方法将86例输尿管阴性结石的患者按随机数字表法分为对照组和观察组,每组43例。对照组采用输尿管逆行插管造影定位联合体外冲击波碎石术（ESWL）治疗;观察组采用大剂量静脉肾盂造影定位联合ESWL治疗。对2组患者的排石情况及并发症（肾绞痛、血尿）发生率进行比较。结果2组患者在经一次碎石后2～20 d内均有不同程度的“细沙样”结石排出体外。2组患者一次治疗后结石的排净率比较差异无统计学意义（P＞0.05）。观察组和对照组分别有4例（9.30%）和5例（11.6%）体外排石失败改行腔内碎石术治疗;观察组发生并发症3例（肾绞痛2例、血尿1例,6.97%）,对照组发生并发症4例（肾绞痛2例、血尿2例,9.30%）,2组体外碎石失败率及并发症发生率的比较差异均无统计学意义（均P＞0.05）。结论大剂量静脉肾盂造影下行输尿管阴性结石ESWL治疗,结石排净率高、安全可靠,是治疗输尿管阴性结石的良好选择。