CT尿路成像（CTU）诊断异位血管导致的肾盂输尿管交界狭窄（UPJO）

 目的 探讨CT尿路成像(computed tomography urography,CTU)诊断异位血管导致的肾盂输尿管交界狭窄(ureteropelvic junction obstruction,UPJO)的价值。 方法  回顾性研究2005年以来本院收治异位血管导致的UPJO患者21例（男性11例,女性10例）,平均32岁。病变位于左侧8例,右侧13例。反复尿路感染10例,患侧腰背部胀痛8例,患侧肾绞痛5例,肉眼血尿3例,体检发现8例。所有患者均行B超检查及CTU检查,同时采用静脉尿路造影(intravenous urography,IVU)检查者16例,行膀胱镜逆行输尿管肾盂造影(retrograde ureteropyelography,RP)者6例。 结果 21例患者CTU检查均显示狭窄部位,其中20例患者发现肾下极异位血管而明确诊断,诊断正确率95.2%(20/21)。16例行IVU检查者2例未见患侧肾脏显影,14例患者显示患侧肾积水,仅2例患者显示肾盂输尿管狭窄部位。行RP检查6例,均显示狭窄部位,但未能明确原因。21例患者中共发现异位血管21根,动脉20根,静脉1根。20根动脉皆在CTU中显示而确诊,1根异位静脉于手术探查时发现。18根异位血管从肾盂输尿管交界处后方通过,3根从前方通过。所有患者均行手术治疗并证实为肾下极异位血管导致的UPJO,行开放手术异位血管离断术12例,同时行肾盂输尿管成形术5例;行腹腔镜下异位血管离断术8例,同时行肾盂输尿管成形术2例,1例行患肾切除术。17例获得随访,时间3~30个月,16例肾积水好转。结论  CTU作为一种无创的检查方式,可以为异位血管导致的UPJO患者进行“一站式”检查(one stop examination),在提供大量超过IVU诊断信息的同时避免RP检查的创伤和相关并发症。

Detection of crossing vessels with ureteropelvic junction obstruction (UPJO) by computed tomography urography (CTU)

Objective  To assess the use of computed tomography urography(CTU) for the detection of crossing vessels with ureteropelvic junction obstruction (UPJO).Methods  Twenty one patients aged 18 to 62 yr (mean age,32) who had been diagnosed with a UPJO were included retrospectively.Of the cases 8 were on the left and 13 on the right side.CTU was performed in every patient and intravenous urography was performed in 16 cases with retrograde ureteropyelography performed in 6 cases.Results  Twenty of 21 patients (95.2%) demonstrated crossing vessels at CTU examination.Fourteen of 16 patients demonstrated hydronephrosis in IVU examination with no patient detected the etiology.There were 20 arteries and one vein detected.All patients were confirmed crossing vessels
with operation.Twelve cases were performed with open operation of vessel devascularization with 5 cases combined with pyeloplasty.Eight cases were performed with laparoscopic procedures of vessel devascularization with 2 cases combined with pyeloplasty.Nephrectomy was performed in 1 case.Conclusions  CTU can be recommended as first line imaging modality for the detection of crossing vessels in patients with UPJO.