多模态三维影像重建技术在尿道狭窄诊断中的应用  

The application of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture

作　　者：冯超 申玉兰[2] 陈磊 张素[4] 吕相国 撒应龙 胡兵 傅强 徐月敏 Feng Chao;Shen Yulan;Chen Lei;Zhang Su;Lyu Xiangguo;Sa Yinglong;Hu Bing;Fu Qiang;Xu Yuemin(Department of Urology, Shanghai Jiaotong University Affiliated 6th People＇s Hospital, Shanghai 200233, Chin)

机构地区：[1]上海第六人民医院泌尿外科,200233 [2]上海第六人民医院放射科,200233 [3]上海第六人民医院超声医学科,200233 [4]上海交通大学MED-X研究所 [5]上海交通大学医学院附属仁济医院泌尿科

出　　处：《中华泌尿外科杂志》2018年第5期367-371,共5页Chinese Journal of Urology

摘　　要：目的 探讨多模态三维影像重建技术在尿道狭窄术前诊断中的可行性及有效性。方法 回顾性分析2012年1月至2017年6月收治的121例男性尿道狭窄患者的病例资料。年龄（34.6±11.9）岁，范围17-63岁。既往有骨盆骨折史71例，骑跨伤史16例，医源性损伤史25例，尿道感染史9例。58例自述肛门存在漏尿。所有患者术前均接受常规顺行加逆行尿道造影检查，诊断为后尿道狭窄71例，前尿道狭窄50例。后尿道狭窄患者采用超薄层CT扫描进行尿道影像三维重建。前尿道狭窄患者采用三维超声进行尿道影像三维重建。所有重建模型均在整体三维影像基础上转化为内镜仿真模式。比较传统尿道造影与三维重建模型在尿道狭窄长度测量上的差异性。同时以手术（后尿道端端吻合术、球部尿道端端吻合术、前尿道替代成形术）实际发现为标准，评估多模态影像学技术在诊断复杂性尿道狭窄中的准确性。结果 58例自述肛门存在漏尿者中，CT三维尿道重建与传统尿道镜检查相比，直肠瘘检出率更高[87.9%（51/58）与77.6% （45/58）]，但差异无统计学意义（χ2＝2.175，P＝0.140）。在后尿道狭窄71例中，尿道造影和CT三维重建测量的狭窄长度的差异无统计学意义[（2.30±1.60）cm与（2.18±1.55）cm，P＝0.91]。前尿道狭窄50例中，尿道造影和三维超声检查在阴茎段[（2.13±0.34） cm与（2.24±0.31） cm，P＝0.13]及球部[（1.98±0.47）cm与（2.13±0.32）cm，P＝0.23）]狭窄段长度测量方面差异均无统计学意义。但尿道三维超声检查在显示舟状窝病变以及尿道周围瘢痕分布方面更具优势。CT的内镜仿真模式在显示尿道腔内壁的还原度以及模拟长度方面优于三维超声。两种模态的三维重建目前均存在后期制作时间较长的不足，CT需要2 h后期制作，超声需要超过24 h后期制作。结论 多模态三维影像重建技术Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally, 121 male patients, suffered with urethral strictures, were enrolled in this study between January 2012 and June 2017. Their age ranged from 17 to 63 years old. The etiology included pelvic fracture in 71 cases, straddle injury in 16 cases, iatrogenic injury in 25 cases, infection in 9 cases. All patients accepted the routine antegrade and retrograde urethrography. The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture. The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures. The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination. The length of stricture was compared between that in traditional urethrography and in 3D dimensional image, based on the results from anastomotic procedure and substitution.Result Among patients, 71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture. In those patients with posterior urethral stricture, no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image[（2.30±1.60）cm vs.（2.18±1.55）cm, P=0.91）]. In patients who complained about the urine leakage from anus, higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination（87.9% vs. 77.6%）. To patients with anterior urethral strictures, no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile： （2.13±0.34） cm vs.（2.24±0.31）cm, P=0.13; Bulbar： （1.98±0.47）cm vs.（2.13±0.32）cm, P=0.23）]. However, the advantage of 3D image could be shown in detecting the lesion of navicular fossa and peri-urethral pathologic fibrosis. In t

关 键 词：多模态影像 三维重建 尿道狭窄 超声 计算机断层扫描 

分 类 号：R695[医药卫生—泌尿科学]