CT对输尿管结石的诊断价值及其对临床治疗的导向作用(附54例分析)

Usefulness of CT scan in the diagnosis and the treatment of ureteral calculi: Report of 54 cases

目的 探讨疑诊输尿管结石的急性肾绞痛病人的ＣＴ表现、ＣＴ诊断价值及其对临床治疗的指导作用。方法５４例患者均未口服对比剂直接ＣＴ平扫，５例平扫后静注泛影葡胺造影剂６０ｍｌ，延迟１０～１５分钟增强扫描。２例盆腔感兴趣区域ＨＲＣＴ扫描。对每一例病人观察记录输尿管结石的部位、大小、有无继发ＣＴ征象。结果 ４５例ＣＴ平扫显示输尿管内高密度结石影；５例未见阳性结石影像，仅有继发ＣＴ征象；肾盂结石、肾实质结石各１例；２例盆腔静脉结石。结石位于输尿管近端者８例，中段４例，远段１２例，输尿管膀胱交界处２１例。３７例有肾盂积水表现，３６例有输尿管积水、３５例有肾周水肿或肾周软组织影。输尿管周围水肿２９例。结石直径大小为２～３５ｍｍ，其中小于４ｍｍ者１７例，４～６ｍｍ者２０例，大于６ｍｍ者８例。结论 输尿管结石ＣＴ诊断，除直接显示高密度输尿管结石及其部位和大小外，还可显示输尿管结石的继发ＣＴ征象，而且对临床治疗方案的制定起指导作用。

Objective To determine the usefulness of CT scan in the diagnosis of ureteral calculi and to assess its guiding role for the treatment. Methods Fifty -four patients with suspectable ureteral calculi from acute renal colic directly underwent CT plain scan without administration of contrast medium. Five patients underwent additional enhancement scan after intravenous injection of metrizamide 60 ml. The interesting area of pelvis cava in two patients also underwent high - resolution CT scan. The presence. the location, and the size in diameter of the calculi as well as with ot without the secondary CT signs from ureteral calculi were observed and recorded for each patient. Results Among all patients, 45 showed ureteral calculi with high - density shadows on CT plain scan, 5 non - showed the positive shadow mentioned above but only showed the secondary CT signs, 2 showed intravenous calculi of pelvis cava, and the remaining 2 showed respectively the calculi of renal pelvis and the calculi of renal parenchyma. According to the location of the calculi within ureter, 8 cases were proximal segment, 4 cases were middle segment, 12 cases were distal segment, and 21 cases were the interface between ureter and bladder. At the same time, 37 cases of hydronephrosis, 36 cases hydroureter, 35 cases of perirenal edema or soft tissue shadow, and 29 cases of periureteral edema were found in all patients. With the size in diameter of the calculi, the ureteral calculi in 45 patients ranged between 2 and 35 mm, i. e. those were smaller than 4 mm in 17 cases, 4 to 6 mm in 20 cases. and larger than 6 mm in 8 cases, Conclusion CT scan in the diagnosis of Ureteral calculi can not only directly demonstrate the presence, the location, and the size in diameter of the calculi but can clearly reveal the secondary CT signs, therefore it is not only very helpfur to diagnose ureteral calculi hut also plays an important guiding role for the treatment.