排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值  

Role of contrast-enhanced voiding urosonography in the diagnosis of pediatric vesicoureteral reflux

作　　者：邹翔宇 孙佩璇 石静[2] 赵海腾[1] 姜大朋 钟量[1] 杜隽[2] 孙杰[1] Zou Xiangyu;Sun Peixuan;Shi Jing;Zhao Haiteng;Jiang Dapeng;Zhong Liang;Du Jun;Sun Jie(Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine Department of Urology,Shanghai 200127,China;Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine Department of Sonog,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心小儿泌尿外科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心超声科,上海200127

出　　处：《临床小儿外科杂志》2022年第2期151-155,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(81900618);上海“科技创新行动计划”扬帆计划(18YF1415000)。

摘　　要：目的探讨排尿性尿路超声造影(contrast-enhanced voiding urosonography,CeVUS)对儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的诊断价值。方法回顾性分析上海儿童医学中心2018年12月至2020年6月116例[232个肾盂-输尿管单位(pyelo-ureter units,PUUs)]因临床疑为VUR而行初筛的患儿以及VUR术后随访资料,116例均行CeVUS,分析CeVUS的应用安全性以及诊断阳性率。同时收集24例患儿(共48个PUUs)的排尿性X线膀胱尿路造影(voiding cystourethrography,VCUG)数据进行结果比对,分析其诊断灵敏度、特异度以及一致性。结果116例均成功行CeVUS检查,无一例发生不良反应。CeVUS诊断阳性69例,诊断阳性率为59.5%。232个PUUs中,反流阳性103个,诊断阳性率为44.4%。24例(48个PUUs)行VCUG检测患儿中,VCUG检测反流阳性PUUs 23个,CeVUS检测反流阳性PUUs25个,共同阳性诊断21个。以VCUG结果为金标准,CeVUS诊断VUR的灵敏度为91.3%,特异度为84%,阳性预测值为84%,阴性预测值为91.3%。CeVUS和VCUG对VUR的诊断有较高的一致性(Kappa值=0.75)。48个PUUs中,VCUG诊断为无反流25个,其中CeVUS诊断无反流21个;同时CeVUS检测到Ⅱ级反流4个,CeVUS与VCUG检查总体一致性为72.9%。另外,对于高级别反流,VCUG诊断为Ⅳ~Ⅴ级VUR 15个中,CeVUS诊断为Ⅲ级1个,其余均为Ⅳ~Ⅴ级;两项检查均诊断为Ⅳ级7个、Ⅴ级3个,Ⅳ~Ⅴ级诊断一致性为66.7%。结论CeVUS对检测和分级原发性膀胱输尿管反流具有一定的诊断意义,且安全、无放射性,可作为膀胱输尿管反流的筛查手段以及术后随访工具。Objective To determine the value of contrast-enhanced voiding urosonography(CeVUS)for diagnosing vesicoureteral reflux(VUR)in children.Methods A total of 116 cases(232 pyelo-ureter units,PUUs)of suspicious VUR and postoperative children were admitted from December 2018 to June 2020.The safety and positive rate were analyzed.Twenty-four children(48 PUUs)were compared with voiding cystourethrography(VCUG)for its sensitivity,specificity,and consistency.Results All of them were examined successfully and no adverse reactions occurred.The diagnosis was positive for CeVUS(n=69)with a positive rate of 59.5%.Among 232 PUUs,103 were positive for VUR with a positive diagnostic rate of 44.4%.Moreover,among 24 patients(48 PUUs)23 were detected by VCUG,25 by CeVUS and 21 were all positive.As compared with VCUG,CeVUS had a sensitivity of 91.3%,a specificity of 84.0%,a positive predictive value of 84% and a negative predictive value of 91.3%.Contrast-enhanced ultrasound and VCUG had a high consistency in the examination of VUR(Kappa=0.75).Among them,VCUG diagnosed no reflux in 25 PUUs and CeVUS in 21 PUUs with 4 grade Ⅱ VUR.The overall consistency rate was 72.9%.Moreover,VCUG diagnosed 15 grade Ⅳ-Ⅴ VUR,except CeVUS Ⅲ diagnosed 1 with a consistency rate of 66.7% in grade Ⅳ-Ⅴ VUR.Conclusion CeVUS has certain diagnostic significance in detecting and grading VUR with its safety and non-radioactive characteristics.It is considered as a first choice for suspected or post-operated VUR in children.

关 键 词：膀胱输尿管返流/诊断 尿路造影术 超声增强造影剂 儿童 

分 类 号：R726.9[医药卫生—儿科]