肾脏动静脉瘘的超声诊断与鉴别诊断  

Ultrasound diagnosis and differential diagnosis of renal arteriovenous fistula

作　　者：章建全[1] 陈佳彬[1] 任吉忠[2] 

机构地区：[1]第二军医大学长征医院超声诊疗科,上海200003 [2]第二军医大学长征医院泌尿外科

出　　处：《第二军医大学学报》2007年第8期878-883,共6页Academic Journal of Second Military Medical University

基　　金：第二军医大学长征医院"三重三优"学科和人才建设专项基金(2005-03-16)~~

摘　　要：目的:回顾6例肾脏动静脉瘘患者的超声诊疗经历,总结不同超声成像模式下肾脏动静脉瘘的声像表现,增强其超声首诊意识,减少漏诊。方法:对6例肾脏动静脉瘘的临床发现线索、超声诊断契机、超声诊断模式、超声诊断与肾动脉造影的符合情况等进行回顾性分析。结果:二维超声提示诊断1例,误诊1例,漏诊4例;彩色多普勒和频谱多普勒超声完全诊断6例;3例超声造影提示患肾静脉内造影剂的到达时间均早于肾实质,瘘腔较大者合并下游灌注区域缺血表现。三维超声重建能逼真勾画瘘腔的形态,精确计算瘘腔容积,并且提供任意角度和平面上的血流剖面图,促进对瘘腔内血流轨迹的认知。结论:超声对肾脏动静脉瘘具有重要的筛查诊断作用,首选彩色多普勒,频谱多普勒具有协同诊断和鉴别诊断价值;超声造影有助于发现肾静脉循环时相的异常以及因分流而造成的肾皮质缺血区;而二维超声诊断价值较低,易导致误诊、漏诊。Objective：To summarize the ultrasound features of renal arteriovenous fistula （RAVF） under various ultrasound imaging modes, so as to avoid missed diagnosis of RAVF on initial ultrasound examination. Methods： The clinical data of 6 patients with RAVF, including the ultrasound evidence, the timing of ultrasound diagnosis, the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography, were retrospectively analyzed. Results： 2D ultrasound had 1 case of correct diagnosis, 1 case of misdiagnosis and 4 cases of missed diagnosis. Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed. Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma; large fistula lumen was associated with ischemia of downstream areas. 3D ultrasound vividly reflected the structure of fistula lumen volume, and provided us with the profiles of blood signal in fistula at different planes and angles, improving our knowledge of blood flow on the fistula. Conclusion： Ultrasound is the first line screening method for RAVF. Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis. Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenchyma area due to shunting. 2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.

关 键 词：肾疾病 动静脉瘘 超声检查 多普勒 彩色 光谱分析 超声造影 三维超声 

分 类 号：R692[医药卫生—泌尿科学]