输尿管上段狭窄或梗阻的影像学诊断与鉴别诊断  

Stenosis or Obstruction Imaging Diagnosis and Differential Diagnosis of Upper Ureteral

作　　者：李兴荣[1,2] 李豪刚[1,2] 刘海辉[1,2] 张玉忠[1,2] 郭学军[3] 曹火乃[1,2] 杨昌云[1,2] 

机构地区：[1]南方医科大学附属深圳市龙华人民医院放射科 [2]深圳市龙华新区人民医院放射科,广东深圳518109 [3]北京大学深圳医院放射科,广东深圳518036

出　　处：《医学综述》2013年第14期2625-2627,2632,共4页Medical Recapitulate

摘　　要：目的探讨输尿管上段狭窄或梗阻的病因、病理与影像相关特点,提高对输尿管上段狭窄或梗阻的认识。方法收集深圳市龙华新区人民医院2009年7月至2012年6月经临床诊断或经手术病理证实的输尿管上段狭窄或梗阻180例,回顾性分析肾输尿管膀胱(KUB)平片、静脉注射肾盂造影(IVP)、CT、MRI表现,探讨输尿管上段狭窄或梗阻的病因、病理与影像相关特点,并对其进行分类、分型。结果 180例输尿管上段狭窄或梗阻依据病因分先天性异常(其中输尿管狭窄8例)36例,占20%,后天性或继发性狭窄144例,占80%;按发病数目分为单发狭窄(局限性隔膜或瓣膜狭窄,节段性狭窄)178例,占99%,多发狭窄2例,占1%;按病变部位分管腔内狭窄140例,占78%,管壁性狭窄35例,占19%,管壁外在压迫性狭窄5例,占3%;按病理表现分器质狭窄180例,但功能性狭窄1例未计入总数内。结论 KUB平片可明确输尿管上段结石诊断,IVP可直观显示输尿管上段腔内导致狭窄或梗阻的原因和肾脏排泄功能,对于肾功能差者逆行肾盂造影作为补充诊断。CT平扫与增强显示输尿管上段狭窄或梗阻的腔内管壁或管外压迫原因,MRI发现狭窄梗阻部位、区分内在性狭窄与外在性狭窄、磁共振尿路水成像直接显示肾功能差中重度积水者效果显著。Objective To discuss the etiology,pathology and imaging characteristics of upper ureteral stenosis or obstruction,to improve understanding of the disease.Methods One hundred and eighty cases of upper ureteral stenosis or obstruction confirmed by clinical diagnosis or by surgery and pathology during July 2009 and June 2012 from Shenzhen Longhua People＇s Hospital were collected,the imaging findings of KUB plain film,IVP,CT,MRI were retrospectively analyzed,the etiology,pathology and image-related characteristics were explored,classified and typed.Results Among the 180 cases,according to etiology,there were 36 cases of congenital anomalies（including 8 cases of ureteral stenosis） which made up 20% of the total,144 cases of acquired or secondary stenosis which made up 80%;according to lesion number,there were 178 cases of single stenosis（limitations diaphragm or valvular stenosis,segmental stenosis） which made up 99% and 2 cases of multiple narrow which made up 1%;according to diseased region,there were 140 cases of cavity narrowness which made up 78%,35 cases of wall stenosis which made up 19% and 5 cases of stenosis of the external wall of oppression which made up 3%;according to pathological feature,there were 180 cases of organic narrowness,one case of functional narrowness which was not included.Conclusion KUB plain film can clarify the calculi diagnosis of the upper ureter.IVP can show the causes of stenosis or obstruction in upper ureter segment cavity and function of renal excretory,which can be regarded as a supplement diagnosis of the retrograde pyelography for the ones who have poor renal function.CT scan and the enhancement can display the reason for oppression on/outside the cavity wall.MRI can find the narrow site of obstruction and distinct intrinsic stenosis and external stenosis.MRU has good effect in directly showing the slight,moderate and severe hydrocephalus of renal function.

关 键 词：输尿管上段 狭窄 影像 诊断 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R445.2[医药卫生—诊断学]