输尿管囊肿患者超声表现与漏误诊分析

目的 分析输尿管囊肿超声检查漏诊、误诊原因.方法 回顾性分析53例输尿管囊肿患者的超声声像图,所有病例均经膀胱镜或手术病理证实.患者均适度充盈膀胱,行泌尿系常规超声检查,适当调节增益,多角度扫查,注意输尿管末端有无呈规律性膨大-缩小的囊状物,并观察囊状物的部位、大小、开口位置及形态变化规律.彩色多普勒血流显像实时观察囊肿开口处喷尿及输尿管向囊肿内喷尿情况.结果 本组53例输尿管囊肿患者中,左侧30例,右侧17例,双侧6例.合并囊肿内结石3例,伴重复肾3例,合并患侧肾发育不全2例,合并患侧孤立肾及巨输尿管1例,伴马蹄肾1例.伴肾功能损害21例,伴泌尿系感染9例.二维超声可直接显示出囊肿的部位、形态、大小及其变化,彩色多普勒血流显像可实时显示输尿管口喷尿征象.经过随访复查,超声首次检查漏诊4例,均在再次超声检查时发现病变.误诊4例,分别误诊为输尿管口脱垂、膀胱结石、输尿管结石、卵巢囊肿.结论 超声检查是输尿管囊肿首选检查方法.仪器调节不当、对本病的特殊超声征象认识不足是导致本病超声检查漏诊、误诊的主要原因.适当调节超声仪器,实时动态观察,充分认识本病,与相关疾病仔细鉴别,可以减少对本病的漏诊和误诊.

Analysis of missed diagnosis and misdiagnosis of ureterocele by ultrasound

Objective To analyze the common causes of missed diagnosis and misdiagnosis of ureterocele by ultrasound.Methods The sonograms of 53 ureterocele patients were retrospectively analyzed.All cases were proved by cystoscopic or operative pathology.The patients with well-filled bladders were examined by routine urinary ultrasound.During examination,gain adjustment and multi-plane scan had been done to find the cyst at the ureteral end with regular expansion and contraction,and to obseve its position,size,opening and movement.Color Doppler flow imaging（CDFI） could real-time display the urinary jet from ureteric orifice into the cyst.Results There were 53 ureterocele cases in this study including 30 left lesions,17 right lesions,and 6 bilateral lesions.And concomitant abnormalities included 3 cystic stones,3 duplex kidneys,2 renal aplasia,1 solitary kidney combined with megaureter,and 1 horseshoe kidney.In addition,abnormal renal function and urinary infection were found in 21 and 9 patients respectively.2D-ultrasound could directly display the position,shape,size,and movement of ureterocele.CDFI could real-time display the urinary jet of ureteric orifice.Four cases which were missed diagnosed by ultrasonography at the first time got diagnosed by follow-up.And there were 4 additional cases misdiagnosed as prolapse of the ureteral orifice,bladder calculus,ureteral calculus and ovarian cyst respectively.Conclusions Ultrasound is the first-choice imaging modality for ureterocele.Inappropriate instrument setting and insufficient understanding of sonographic appearance of ureterocele are the primary causes for missed diagnosis and misdiagnosing.The missed diagnosis and misdiagnosis of this disease could be reduced by proper adjustment,real time observation,and sufficient knowledge of this and related disease.