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目的 总结肾绞痛患者排泄性静脉尿路造影 (IVU)延时 4～ 4 8h患侧尿路显影并明确结石梗阻位置、X光下定位行ESWL治疗的经验。方法 39例急性肾绞痛患者 ,B超发现轻度肾积水 ,KUB未能明确诊断 ,行IVU6 0min不显影或呈“白肾”。在解痉治疗的同时 ,延时 4～ 4 8hX光下观察“白肾”及尔后出现的结石以上肾盂输尿管显影 ,明确输尿管结石及梗阻部位 ,立即在体外冲击波碎石机上准确定位碎石。排石后复查IVU和B超 ,观察患侧肾功恢复情况。结果 碎石机X光下原定位困难或不能定位的 39例患者经延时显影后能快速定位并碎石 ,碎石过程中清晰可见造影剂通过原梗阻处 ,肾绞痛症状迅速缓解 ,全部患者于碎石 2周内排石 ,其中 2 3例排石后 2周～ 3个月复查IVU患肾及输尿管正常。结论 输尿管结石急性梗阻所致患肾不显影 ,超长延时可显影并明确结石及梗阻部位 ,在此基础上定位行ESWL治疗 ,能及时缓解症状和解除梗阻。
OBJECTIVE: To summarize the experience of ileal urinary imaging in patients with renal colic during lag time of 4 ~ 48 h and the location of stone obstruction, and the location of ESWL in X-ray. Methods Thirty-nine patients with acute renal colic were diagnosed with mild hydronephrosis by B-mode ultrasonography. KUB failed to confirm the diagnosis. IVU 60 min was not developed or showed “white kidney.” Spasm in the treatment at the same time, the delay 4 ~ 48hX light under the observation of “white kidney” and after the above stones appear ureteroscopic ureteral calculi clear ureteral stones and obstruction site, and immediately accurate on the extracorporeal shock wave lithotripsy lithotripsy gravel. After row of stone review IVU and B superficial, observed ipsilateral kidney function recovery. Results 39 cases of lithotripsy patients who were difficult to locate or could not be located under X-ray lithotripsy were rapidly located and graded after delaying development. The process of lithotripsy clearly showed that the contrast agent passed the original obstruction and the symptoms of renal colic were relieved rapidly. Patients in the rubble within 2 weeks row of stone, of which 23 cases of stone row 2 to 3 months after IVU renal and ureteral normal. Conclusions The ureteral calculi caused by acute obstruction of the ureteral calculi does not develop, the long delay can be developed and clear stones and obstruction site, on this basis positioning ESWL treatment can relieve symptoms and relieve the obstruction in time.