原发性输尿管癌的诊断与治疗(附28例报告)

目的:提高原发性输尿管癌的诊治水平。方法:回顾性分析2 8例经病理证实的原发性输尿管癌,对其诊断与治疗进行讨论。结果:2 8例证实均为移行细胞癌,主要症状有:肉眼血尿、患侧腰部疼痛和肾积水。经静脉肾盂造影,膀胱镜检查,逆行肾盂造影,CT检查,术前确诊19例,术前确诊率67.8%。2 8例病人均手术治疗,采用三种手术方式,其中2 5例得以随访,死亡18例。结论:肉眼血尿,患侧腰部疼痛和肾积水是原发性输尿管癌的主要临床症状;静脉肾盂造影、膀胱镜检查和逆行肾盂造影是原发性输尿管癌的主要检查方法;患肾、输尿管全长和膀胱袖套状切除术,是原发性输尿管癌的主要术式。     

原发性肾盂输尿管癌的诊断与治疗（附45例报告）

目的：提高肾盂输尿管癌的诊治水平。方法：回顾性分析我院自2000年1月～2008年3月收治的45例原发性肾盂输尿管癌患者的临床资料。结果：临床表现有血尿40例,腰痛8例,体检发现肾积水1例。阳性率较高的检查有逆行尿路造影、CT、MRI和输尿管镜检查,阳性率分别为66．7％（8／12）、78．8％（26／33）、90．0％（9／10）和90．0％（9／10）。35例（87．5％）做了肾输尿管全长切除、膀胱袖状切除术。35人（77．8％）得到随访,10例在术后13（5～33）个月内14次发生膀胱肿瘤,1例输尿管癌术后3．5年发现对侧肾盂癌,14例死于癌转移,5年总体生存率为34．3％（12／35）。结论：对反复出现的肉眼血尿、腰痛和肾积水患者要考虑本病的可能,联合应用几种检查方法是提高诊断率的关键,肾输尿管全切、膀胱袖状切除术是主要治疗方法。     

逆行尿路造影在现代影像学中对肾盂输尿管连接部梗阻的诊断价值(附55例报告)

目的：对比分析逆行尿路造影与其他影像学方法对肾盂输尿管连接部梗阻（UPJO）的诊断，评价逆行尿路造影在现代影像学方法中对该疾病的诊断价值。方法：回顾分析55例UPJO患者的临床资料。结果：B超检查48例，确诊15例，所有病例皆提示不同程度肾积水，未能做出病因诊断。静脉肾盂造影检查42例，20例确诊，8例做出病因诊断。逆行尿路造影检查28例，皆获确诊，25例做出病因诊断。MRU检查7例，皆获确诊，5例做出病因诊断。结论：逆行尿路造影确诊率高且有良好的病因诊断，但仍有其不足之处，检查对象应针对其他诊断方法未能诊断者和成人，可在手术前检查为手术提供指导。MRU检查对UPJ0诊断效果好，在某些方面具有逆行尿路造影无可替代的优势。B超仅做为初步筛选和随访检查。静脉肾盂造影对肾积水和梗阻段病变严重的UPJO未能显示出临床诊断价值。     

输尿管软镜在上尿路疾病诊治中的应用

对血尿病人的诊断,过去往往停留在B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查、尿脱落细胞学检查及CT等,这些检查往往未能明确诊断。肾血管造影检查价格昂贵且为有创检查,有些病人也未能明确诊断。输尿管硬镜由于本身的特点,往往只能观察到输尿管的病变,对肾盂、肾盏的病变则鞭长莫及。2003年2月~2007年2月,我们应用输尿管软镜对20例上尿路疾病进行检查治疗,效果良好,报道如下。1临床资料与方法1.1一般资料本组20例,男12例,女8例。年龄23~56岁,平均42岁。左侧9例,右侧11例。肉眼血尿2例,镜下血尿10例,病程1~2个月,无其他临床症状及合并症。常规行B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查、尿脱落细胞学检查以及CT检查等(其中2例行肾动脉造影检查)均未能明确诊断。尿红细胞形态检查提示主要为正常形态的红细胞。病例选择标准:原因不明的上尿路单侧肉眼血尿;②尿路单侧尿液细胞学检查阳性;③有可能需要行上尿路腔内治疗;④常规行B超、静脉肾盂造影、逆行肾盂造影、膀胱镜检查及CT检查等均未能明确诊断。病例排除标准:严重出血性疾病;②患者不能耐受手术和麻醉;③急性尿路感染者;④尿道狭窄。1.2方法采用连续硬膜外麻...     

先天性输尿管中段狭窄七例报告

先天性输尿管中段狭窄相当罕见。作者报道7例病例，分析此病与其他梗阻性疾病在术前诊断以及外科处理方面的异同。回顾性分析1998—2002年诊断为输尿管中段狭窄的7例患儿的病历和影像学资料。5例新生儿表现为孕期肾积水，另2例在15岁时才发现，1例在检查钝性损伤时诊断，1例因为腹痛和腹部包块发现。影像学检查包括肾脏超声、排尿期膀胱尿道造影、核素肾扫描和CT。所有患者均行逆行肾盂造影。手术标本术后行病理检查。结果：孕期肾积水是最常见的表现，     

原发性输尿管癌的诊断（附31例报告）

目的提高原发性输尿管癌术前诊断水平。方法结合有关献对1980年10月～1999年10月收治的31例原发性输尿管癌的临床特点及各种检查方法的选择进行分析。结果31例术后均经病理检查证实。首发症状以肉眼血尿最常见,术前诊断符合率为100％。结论凡原因不明的血尿患,经B超或静脉尿路造影检查发现肾积水或肾不显影时应考虑到原发性输尿管癌的可能。认为在各种检查中逆行肾盂造影、膀胱镜检查及输尿管镜检查是最重要的诊断方法。     

逆行性肾盂造影在输尿管肿瘤诊断与鉴别诊断中的价值

目的探讨逆行性肾盂造影在输尿管肿瘤的诊断与鉴别诊断中的价值并提高输尿管肿瘤病变的诊断与鉴别诊断的水平。方法对手术病理证实为输尿管肿瘤的患者17例，术前均行腹部超声、尿路平片（KUB）、静脉尿路造影（IVU）、肾CT（14例）、MR尿路水成像（8例）及逆行性肾盂造影检查并对结果进行分析。结果本组病例中有15例行逆行性肾盂造影检查即获得明确的影像学诊断；2例因梗阻严重，导管无法通过狭窄段，无法显示病变输尿管的情况而诊断为输尿管梗阻，原因待查，阳性率达88．2％。结论逆行性肾盂造影检查对输尿管肿瘤的诊断阳性率高，对判定病变性质及范围亦有较大的意义。     

原发性输尿管癌的早期诊断与治疗(附26例报告)

目的：提高原发性输尿管癌的诊治水平。方法：回顾性分析26例原发性输尿管癌临床资料，比较各种检查方法，总结诊治经验。结果：26例术后均行病理检查证实为移性细胞癌。术前经B超、IVU、膀胱镜及逆行肾盂输尿管造影、CT、MRU等确诊24例(92．3％)。结论：联合应用B超、IVU、膀胱镜、逆行肾盂输尿管造影和CT、MRU检查方法，可提高原发性输尿管癌的诊断符合率。膀胱镜、逆行肾盂输尿管造影是原发性输尿管癌的最基本的检查手段。治疗以手术为主。     

先天性肾盂输尿管交界部梗阻的影像学诊断方法比较

为提高对先天性肾盂输尿管交界部梗阻(UPJO)的诊断,评价影像诊断的价值,对80例先天性UPJO的病人的影像学检查资料进行回顾性比较分析,结果表明所有病人均作了静脉肾盂造影及B超检查;50例行逆行肾盂输尿管造影;20例曾行腹部CT检查;利尿性肾核素检查25例。75例外科手术治疗。先天性UPJO可分为两大类,动力性和机械性梗阻。动力性梗阻在临床及影像学表现上无特异性,机械性梗阻有其特征性的影像学表现。因此认为尿路造影诊断可以明确诊断,优于CT、B超、同位素的诊断价值。     

输尿管肿瘤的早期诊断

目的：探讨早期诊断输尿管肿瘤的有效方法。方法：回顾分析37例输尿管肿瘤的早期临床症状及辅助检查阳性发现的特点。结果：持续性镜下或肉眼血尿占97．3％，同侧肾积水占67．6％，伴尿路感染症状占43．2％；术前诊断30例，术中诊断7例；螺旋CT成像确诊率72．2％，输尿管镜确诊率70．0％，逆行造影确诊率50．0％，输尿管拉网活检3例均确诊。结论：输尿管肿瘤早期诊断较为困难，持续性镜下血尿并有原因不明的肾积水者，应及早行螺旋CT成像和输尿管肾镜检查。输尿管拉网活检可作为早期诊断输尿管肿瘤的方法之一。     

原发性输尿管恶性肿瘤的诊断(附57例报告)

目的：提高原发性输尿管恶性肿瘤的诊断水平。方法：回顾性总结１９７３￣１９９７年经手术证实的原发性输尿管恶性肿瘤５７例,并对其临床特点及各种检查方法的选择进行分析。结果：术前诊断符合率为９６．５％（５５／５７）。结论：凡原因不明的血尿患者,经Ｂ超或静脉尿路造影检查发现有肾积水或肾不显影时应考虑到原发性输尿管肿瘤的可能。在各种检查中,以逆行输尿管造影的诊断符合率最高。     

NMSCT 输尿管重建联合肾血流图诊断输尿管结石

目的:探讨非增强MSCT(NMSCT)输尿管重建联合肾血流图诊断输尿管结石的价值。方法:采用输尿管重建技术,对162例初步诊断为输尿管结石的患者进行NMSCT扫描,同时行核素肾动态显像检查,结合患者的临床资料,回顾性分析NMSCT联合肾血流图的应用价值。结果:最终明确诊断输尿管结石102例,非输尿管结石60例,结石平均宽度为(7.6±2.8) mm。NMSCT诊断输尿管结石的灵敏度和特异性分别为88.2%、91.7%,肾血流图的灵敏度和特异性分别为83.3%、88.3%,NMSCT联合肾血流图诊断输尿管结石具有最高的灵敏度92.2%和特异性93.3%(表1)。NMSCT显示输尿管结石患者肾积水情况一定程度上能够提示肾血流图显示的泌尿系统梗阻严重程度(即肾功能)。结论:NMSCT输尿管重建可以获得良好的尿路成像,能准确、清晰地显示输尿管结石。NMSCT结合肾血流图可以完成输尿管结石的诊断及肾功能评价。对临床诊断及治疗具有重要价值,可以替代传统CTU检查。     

螺旋CT尿路三维重建诊断上尿路梗阻性病变(附37例报告)

目的　探讨螺旋CT尿路三维重建技术在上尿路梗阻性疾病诊断中的应用价值。　方法　对 37例上尿路梗阻患者进行螺旋CT薄层扫描和尿路三维重建 ,必要时行CT血管造影。　结果　 37例均获明确诊断 ,其中输尿管癌 8例 ,膀胱癌 2例 ,输尿管结石 9例 ,输尿管良性狭窄 7例 ,先天异常 7例 ,盆腔肿瘤 4例 ,除盆腔肿瘤外均行手术治疗证实诊断 ,术中所见与螺旋CT扫描结果一致。　结论　螺旋CT尿路三维重建具有三维成像、分辨率高、检查时间短、侵袭性小等优点 ,可能成为诊断上尿路梗阻性病变最有价值的检查方法。     

输尿管阴性结石的影像学分析

目的 探讨输尿管阴性结石的影象学诊断价值。方法 对78例输尿管阴性结石的常规B超、利尿性B超、逆行尿路造影、经皮肾穿刺造影、CT检查结果进行比较分析。结果 五种检查方法中CT诊断符合率最高(96．42％)，其次是利尿性B超(85．29％)，经统计学处理有显著性差异(P＜0．01)。结论 CT诊断输尿管阴性结石优于其它方法，并不受年龄和部位的限制，B超先确定梗阻部位是关键。     

经皮肾穿刺造瘘在梗阻性肾积水（脓）中的临床价值

目的：探讨经皮肾穿刺造瘘（PCN）在梗阻性肾积水（脓）中的临床应用价值.方法：对86例肾积水（脓）患者先行超声引导经皮肾穿刺造瘘引流.待肾功能改善、机体状况好转或经引流及造影确定诊断,其中结石引起的肾积水（脓）69例.非结石性肾积水（脓）17例,合并脓肾31例.52例行经皮肾镜取石碎石术,17例行后腹腔镜肾盂、输尿管切开取石术,6例行肾盂切开取石术后加行肾盂输尿管成型术;5例行输尿管狭窄段切除端端吻合术;3例行肾下盏-输尿管吻合术;3例行输尿管皮肤造瘘术.结果：86例患者均穿刺成功,及时解除梗阻,71例患者肾功能恢复正常;9例肾功能改善,维持在轻中度氮质血症水平;6例肾功能无改善.结论：PCN所建立的通道为缓解病情、病因诊断和二期手术打开方便之门,尤其是对急性梗阻性脓肾及结石梗阻性肾积水（脓）的诊治具有重要的应用价值.     

Dynamic renal scintigraphy in children with vesicoureteral reflux and suspected coexisting ureteropelvic junction obstruction

PURPOSE: We evaluated whether findings on voiding cystourethrography suggesting ureteropelvic junction (UPJ) obstruction coexists with vesicoureteral reflux (VUR) are associated with parameters on dynamic renal scintigraphy that support significant obstruction. MATERIALS AND METHODS: We reviewed records of 44 patients referred for scintigraphy after voiding cystourethrography performed at age 1 day to 9.4 years (mean 7 months, median 1.7 months) showed VUR and findings suggestive of UPJ obstruction (blockage of contrast material at the UPJ, contrast dilution in the renal pelvis, slow renal pelvic drainage). Results were correlated with Society for Fetal Urology hydronephrosis grade and ureteral morphology. RESULTS: Halftime was in the obstructive range (20 minutes or greater) for 7 of 47 kidneys (15%). The prevalence of a post-furosemide pelvicaliceal drainage halftime in the obstructive range increased with hydronephrosis grade (0% grade 1, 17% grade 2, 50% grade 3 to 4, p = 0.002) but did not vary with ureteral morphology (p = 0.08). In 12 of 38 cases (31%) where suspected UPJ obstruction was unilateral and a contralateral kidney was present differential uptake of the affected kidney was less than 45%. The prevalence of differential uptake less than 45% was higher in patients with than without ureteral dilatation (48% vs 12%, p = 0.02) but did not vary with hydronephrosis grade (p = 0.93). CONCLUSIONS: In children with VUR and suspected coexisting UPJ obstruction dynamic renal scintigraphy may support significant obstruction when hydronephrosis is at least moderate in degree or ureteral dilatation is present but is unlikely to do so if neither is observed.     

输尿管息肉的影像学诊断

目的　提高输尿管息肉的诊断水平。方法　对 35例 37条输尿管息肉患者的临床资料进行分析。结果　①息肉位于输尿管上段者 2 4例 ,占总数的 6 1.5 % ;②中度肾积水 2 2例 ,占总数的 5 6 .4 % ;③输尿管梭形膨大扩张 ,范围大于充盈缺损长度者 37条 ,迂曲走行 2 1条 ;④输尿管及其内充盈缺损的形态可变。结论　尿路造影是诊断输尿管息肉的有效方法。     

Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction

PURPOSE: We evaluated magnetic resonance urography (MRU) appearances in symptomatic hydronephrosis in pregnancy and compared urographic patterns in physiological and calculous disease. MATERIALS AND METHODS: A total of 24 consecutive pregnant women with symptomatic hydronephrosis underwent MRU, comprising an overview fast T2-weighted examination of the abdomen and pelvis, and thick slab, heavily T2-weighted MRU images, followed by focused, high resolution T2-weighted sequences obtained in an axial and coronal oblique plane through the level of ureteral caliber change. RESULTS: Of these 24 pregnant women 15 were found to have physiological hydronephrosis, 7 had calculous disease and 2 had preexisting urinary anomalies. MRU findings in physiological hydronephrosis cases were extrinsic compression of the middle third of the ureter, no filling defect and a collapsed ureter below it. Obstruction by ureteral calculi was seen at points of ureteral narrowing in the ureter, that is at the vesicoureteral junction in 2 cases, in the compressed mid ureter in 3 and at the pelviureteral junction in 1. Nonobstructive renal calculi were seen in another patient. Calculi presented throughout pregnancy but physiological hydronephrosis presented only in the late second and third trimesters. With distal calculi the MRU appearance was the double kink sign with constriction at the pelvic brim and the vesicoureteral junction with a standing column of urine in the pelvic ureter. There was renal edema and perirenal extravasation. Small calculi were only identified using high resolution T2-weighted magnetic resonance imaging. CONCLUSIONS: MRU is a valuable and well tolerated investigation for evaluating painful hydronephrosis in pregnancy. There are characteristic and differing urographic appearances in physiological and calculous obstruction.     

Congenital mid ureteral strictures

PURPOSE: Congenital mid ureteral stricture is rare. We report 7 cases, and discuss the differences in preoperative evaluation and surgical management compared to other obstructive entities. MATERIALS AND METHODS: Medical records and imaging studies of 7 children identified with mid ureteral strictures between 1998 and 2002 were reviewed retrospectively. Five newborns presented with prenatal hydronephrosis, and 2 children presented at age 15 years, one in the course of evaluation of blunt trauma, and one due to pain and abdominal mass. Imaging studies included renal ultrasound, voiding cystourethrography, radionuclide renography and computerized tomography. All patients underwent retrograde pyelography. Pathological examination of each specimen was undertaken at the respective institutions. RESULTS: Prenatal hydronephrosis was the most common presentation. There were no urinary tract infections. All patients had significant obstruction on the affected side. No patient had vesicoureteral reflux. After imaging but before surgery the urinary obstruction was believed to be at the ureteropelvic junction in 4 patients and the ureterovesical junction in 2, and secondary to posterior urethral valves in 1. At cystoscopy all of the affected ureters had a normally located and normally configured orifice. Retrograde pyelography led to an accurate diagnosis of mid ureteral narrowing in all patients. Six patients underwent ureteroureterostomy, all of whom had satisfactory outcomes. In 1 of these patients contralateral nephrectomy was performed due to nonfunction of the multicystic dysplastic kidney. The remaining patient underwent nephrectomy for ipsilateral end stage kidney disease and hydronephrosis. In this patient the ureters were stenotic and suggested asymmetry in the thickness of the muscular coat, perhaps secondary to extrinsic compression. CONCLUSIONS: Congenital mid ureteral stricture is rare. Renal ultrasound and radionuclide renography alone do not reliably demonstrate the site of obstruction. Retrograde pyelography at the time of surgical correction of presumed ureteral obstruction is an important adjunct for correctly identifying the site of narrowing in the affected ureteral segment, unless the ureter has been imaged with another modality.