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目的提高急性上尿路梗阻性无尿的诊断水平。方法对58例急性上尿路梗阻患者的临床表现、影像学检查结果和梗阻原因进行总结、分析。结果临床表现为无尿58例、肾区疼痛41例、肾区叩击痛33例、高血压20例、血尿素氮和肌酐升高57例、高血钾8例。MRU、B超、X线(包括KUB、IVU、逆行肾盂造影)、CT、MRI等影像学检查为主要辅助检查。对上尿路梗阻的检出率,MRU为100%(25/25),B超为88%(50/57),CT/MRI为60%(6/10),X线为49%(19/39);MRU、B超检出率显著高于X线和CT/MRI(P<0.05)。对梗阻病因的检出率,MRU为88%(22/25),B超为46%(26/57),X线为46%(18/39),CT/MR为50%(5/10);MRU检出率显著高于B超、X线和CT/MRI(P<0.05)。梗阻病因为结石27例、肿瘤18例、输尿管狭窄4例、腹膜后纤维化3例、药物结晶2例、肾结核1例,不明原因3例。结论影像学检查对急性上尿路梗阻性无尿的诊断具有重要价值,MRU、B超对梗阻的检出率较高,MRU在病因诊断方面具有优势。结石是最常见的上尿路梗阻病因,其次为肿瘤。
Objective To improve the diagnosis of obstructive anuria in the upper urinary tract. Methods The clinical manifestations, imaging findings and obstruction of 58 patients with acute upper urinary tract obstruction were summarized and analyzed. Results of clinical manifestations of anuria in 58 cases, 41 cases of renal pain, kidney percussion pain in 33 cases, 20 cases of hypertension, blood urea nitrogen and creatinine increased in 57 cases, hyperkalemia in 8 cases. MRU, B ultrasound, X-ray (including KUB, IVU, retrograde pyelography), CT, MRI and other imaging studies as the main auxiliary examination. The prevalence of upper urinary tract obstruction was 100% (25/25) for MRU, 88% (50/57) for B-ultrasound, 60% (6/10) for CT / MRI and 49% for X-ray / 39). The detection rate of MRU and B ultrasound was significantly higher than that of X-ray and CT / MRI (P <0.05). The detection rate of obstruction was 88% (22/25) for MRU, 46% (26/57) for B-ultrasound, 46% (18/39) for X-ray, and 50% for CT / MR ). The detection rate of MRU was significantly higher than that of B ultrasound, X-ray and CT / MRI (P <0.05). Obstructive disease due to stones in 27 cases, 18 cases of tumor, ureteral stenosis in 4 cases, 3 cases of retroperitoneal fibrosis, drug crystallization in 2 cases, 1 case of renal tuberculosis, unknown cause in 3 cases. Conclusions Imaging examination is of great value in the diagnosis of acute upper urinary tract obstruction of anuria. MRU and B-ultrasound have higher detection rate of obstruction, and MRU has advantages in diagnosis of etiology. Stones are the most common cause of upper urinary tract obstruction followed by tumors.