马蹄肾的首诊表现、合并症及影像检查分析

Clinical Manifestations at Initial Diagnosis,Complications and Imaging of Horseshoe Kidney

目的：马蹄肾是一种常见的先天性肾脏发育畸形，容易被漏诊或者误诊。本研究的目的是加深对马蹄肾临床和影像表现的认识。方法：回顾分析2008年1月-2013年6月在解放军总医院确诊为马蹄肾患者的一般情况、首诊表现、合并症及影像学检查结果。结果：（1）一般资料：共有53例影像诊断为马蹄肾患者纳入本研究，男：女为1．3：1；平均年龄为（40．2±17．5）岁。（2）首诊时表现：以腰痛、尿检异常等泌尿系统疾病相关临床表现为主诉就诊的28例（52．8％）；体检或因其他疾病意外发现的25例（47．2％）。（3）合并症：马蹄肾合并肾实质病变[表现为血尿或／（和）蛋白尿及肾衰竭]16例（30．2％），尿路感染10例（18．9％），泌尿系结石10例（18．9％），肾积水10例（18．9％），肾囊肿7例（13．2％）。（4）影像学检查：25例患者进行了超声检查，其中6例（24．0％）被误诊；16例患者接受了静脉肾盂造影检查，其中1例（6．3％）被漏诊。29例进行了肾脏CT检查、10例进行了肾脏MRI检查，无1例漏诊或误诊。13例ECT检查提示双肾影轮廓欠清晰或呈倒“八”字，放射性同位素分布存在不同程度减低、甚至单侧肾脏不显影。结论：马蹄肾首诊时泌尿系统表现约占一半；常见的合并症是肾实质病变、尿路感染、结石、肾积水及肾囊肿；CT或MRI是诊断马蹄肾最准确的手段。

Objective：Horseshoe kidney （HSK） is a common congenital renal anomaly that is often misdiagnosed or missed in diagnosis. This work presents further understanding of clinical manifestations and imaging of HSK. Methods： The patients were in- volved who were diagnosed with HSK by imaging examination at the Chinese PLA General Hospital between January 2008 and June 2013. The general information, clinical manifestations when initially diagnosed, complications and imaging of these HSK patients were retrospectively studied. Results： （ 1 ） General information ： Fifty - three patients with HSK were enrolled with male - female ratio of 1.3：1. （2） Clinical manifestations at initial diagnosis： Twenty- eight cases （52.8%） were discovered because of symptoms, as waist pain and abnormal uroscopy,related to urological diseases, and 25 cases （47.2%） were discovered incidentally because of non - urological diseases or physical examinations. （3） Complications ： The complications of HSK related to urinary system were more common including kidney diseases （proteinuria, hematuria and impaired renal function, 16 cases, accounting for 30.2% ）, urinary tract infection （ cases, 18.9% ）, urolithiasis （ 10 cases, 18.9% ）, hydronephrosis （ 10 cases, 18.9% ）, renal cyst （ 7cases, 13.2% ）. （4） Imaging： Uhrasonography （US） was performed in 25 patients,of whom 6 cases （24.0%） were missed in diagnosis. Of 16 patients who received intravenous pyelography （IVP）, one case （6.3%） was missed. CT was performed in 29 patients and magnetic reso- nance imaging （MRI） was performed in 10 patients, and none was missed by CT or MRI. Single photon emission computed tomo- graphy （ECT） was performed in 13 patients and revealed indistinct kidney outlines appearing U -shaped or displayed unilateral reno- gram invisibility. Conclusion： Approximately one - half of the HSK patients were found horseshoe kidney because of symptoms rele- vant to urinary system diseases. The common complications of HSK included kidney disease, urinary tract infection, urolithiasis, hydro- nephrosis and renal cyst. CT and MRI were reliable modalities to confirm HSK.