排泄性尿路造影与CT诊断肾结核的价值比较  

Comparison of value of intravenous pyelography and CT in the diagnosis of renal tuberculosis

作　　者：王慧 高侯东 常亮 

机构地区：[1]榆林市中医医院放射科,陕西榆林719000 [2]榆林市中医医院CT室,陕西榆林719000

出　　处：《海南医学》2017年第24期4046-4048,共3页Hainan Medical Journal

摘　　要：目的探讨排泄性尿路造影与CT在肾结核中的诊断价值。方法选择2013年11月至2017年6月间在榆林市中医医院临床拟诊为肾结核患者60例为研究对象,所有患者均接受排泄性尿路造影及肾脏CT检查,观察肾结核的肾盂静脉造影及螺旋CT表现,比较肾盂静脉造影及螺旋CT对肾结核的诊断效力。结果最终经手术病理确诊为肾结核49例。49例肾结核患者中,排泄性尿路造影显示肾盂肾盏不规则扩张及变窄28例,肾盂内不规则型充盈缺损6例,肾皮质脓肿3例。CT表现为肾实质内略低密度伴不规则形钙化11例;肾盂及肾盏变形、扩张积水,边缘不规则增厚34例;肾实质内脓肿5例。强化CT显示病灶实质部分呈轻度持续性强化,延迟扫描显示肾盂肾盏延迟充盈。肾脏CT对肾结核诊断准确率为91.8%,明显高于排泄性尿路造影的75.5%,差异有统计学意义(P<0.05)。肾脏CT和静脉肾盂造影对肾实质瘢痕化(59.2%vs 30.6%)、肾区钙化灶(83.7%vs 48.9%)、输尿管壁增厚(79.6%vs 38.8%)、肾功能减退(69.4%vs 46.9%)的显示率比较,前者明显高于后者,差异均有统计学意义(P<0.05)。结论螺旋CT对肾结核具有更高的诊断价值。Objective To investigate the value of intravenous pyelography and CT in the diagnosis of renal tuberculosis.Methods Sixty patients suspected as renal tuberculosis who suspected in Yulin Hospital of traditional Chinese Medicine from Nov.2013 to Jun.2017 were selected as the research objects.All patients underwent intravenous pyelography and CT examination.The intravenous pyelography and spiral CT findings were observed.The efficacy of intravenous pyelography and spiral CT in the diagnosis of renal tuberculosis were compared.Results In 49 cases of renal tuberculosis,intravenous pyelography showed irregular dilatation and narrowing of the renal pelvis and calyx in 28 cases,irregular filling defect in the renal pelvis in 6 cases,and renal cortical abscess in 3 cases.CT showed slightly low density of renal parenchyma with irregular calcification in 11 cases,renal pelvis and calyx deformation,dilation and hydronephrosis,irregular edge thickening in renal pelvis and calyx in 34 cases,and renal parenchyma abscess in 5 cases.The enhanced CT showed slight persistent enhancement in the parenchyma of the lesion.Delayed scan showed delayed filling of the renal pelvis and renal calyx.The diagnostic accuracy of renal CT for renal tuberculosis was 91.8%,which was significantly higher than that of intravenous pyelography（75.5%）,and the difference was statistically significant（P0.05）.CT had higher detection rates in renal scarring（59.2% vs 30.6%）,renal calcification（83.7% vs 48.9%）,ureteral wall thickening（79.6% vs 38.8%）,renal dysfunction（69.4% vs 46.9%） than intravenous pyelography,and the differences were statistically significant（P0.05）.Conclusion Spiral CT has a higher diagnostic value in the diagnosis of renal tuberculosis.

关 键 词：电子计算机体层摄影 排泄性尿路造影 肾结核 诊断 

分 类 号：R527.1[医药卫生—内科学]