先天非结石梗阻性肾积水影像诊断与病理基础

目的:回顾分析输尿管先天非结石梗阻性肾积水影像特征,提高对肾积水致病原因及输尿管无病变侧肾继发性改变特征的识别能力。方法:根据静脉肾盂造影、逆行肾盂造影、B型超声波及CT检查结果,经手术和病理证实的输尿管先天非结石梗阻性肾积水86例进行对照研究。结果:中、重度肾积水占86.0%,致病因素中输尿管狭窄占83.7%,其中一侧输尿管多处狭窄和(或)双侧输尿管狭窄占20.9%。肾积水的不同影像特征与输尿管梗阻的部位不同有关,轻度肾积水的肾盂改变类似"壶腹"型肾盂。结论:先天非结石梗阻性肾积水的病因多样,但多伴有输尿管狭窄。输尿管狭窄具有单侧多发及双侧同时发病的特点。一侧肾重度积水时,另一侧肾盂改变注意不要误诊为"壶腹"型肾盂。输尿管狭窄的定位诊断以逆行肾盂造影与静脉肾盂造影相结合为首选。

Imaging diagnosis and pathological basis of congenital non-calculous obstructive ureteric hydronephrosis

Objective:To enhance the discrimination to the congenital non-calculous obstructive ureteric hydronephrosis and the characteristics of secondary changes of the kidney without ureteric stricture by retrospective analysis of image features of the hydronephrosis.Methods: Based on the manifestations of intravenous pyelography,retrograde pyelography,CT scan and B-type ultrasonic examination,86 cases of congenital non-calculous obstructive hydronephrosis,which were identified by surgery and pathological examination from January 1998 to January 2004,were analyzed retrospectively.Results: The incidence of moderate and severe hydronephrosis was 86.0%.Among them,the etiological factor in 83.7% patients was ureterostenosis,with multiple stricture of unilateral ureter or bilateral ureterostenosis in 20.9% of them.The various image characteristics of congenital non-calculous obstructive hydronephrosis were closely related to the different location of the stricture of the ureter.Conclusion: The pathogenesis of congenital non-calculous obstructive hydronephrosis is numerous,mostly accompanied with stricture of ureter.The ureteric stricture has the tendency of multiple strictures.While severe hydronephrosis occurred in one kidney,the attention should be paid to the changes of the other kidney and should not be misdiagnosed as " ampulla-type" renal pelvis.The first choice for locating the ureteric lesion is the combination of retrograde pyelography with intravenous pyelography.