原发性输尿管癌的综合超声诊断

Comprehensive ultrasonographic diagnosis in primary ureteral cancer

目的探讨提高原发性输尿管癌超声初诊水平的方法。方法回顾性分析1997年2月—2005年4月我院经手术及病理证实的51例原发性输尿管癌患者的经腹、经阴道或经直肠超声及三维超声检查的临床资料,包括部分患者的彩色多普勒血流成像(CDFI)及脉冲多普勒检测结果。结果超声显示输尿管肿瘤24例、髂血管旁淋巴结肿大1例、腹膜后肿物2例、附件肿瘤1例、膀胱肿瘤5例、输尿管结石2例。超声诊断符合率为47.1%(24/51)、误诊率21.5%(11/51)、漏诊率31.4%(16/51)。位于输尿管内的肿瘤超声显示为均质的低回声,较输尿管积水回声略高,肿物沿输尿管轴向分布,轴向长径大于前后径,而位于输尿管末端突向膀胱内的肿瘤以中等回声为主,肿瘤形态不规则。超声对输尿管上段肿瘤及输尿管下末段突入膀胱壁内的肿瘤显示较好,中段及中下段较差。对于下段可疑病变,可采用经阴道或经直肠超声检查,当肿瘤显示清晰时,对其进行三维重建,显示病变立体结构及与周围关系。超声确诊的24例输尿管癌患者CDFI显示肿瘤内血流丰富,可见花篮样、枝条状或棒样血流信号,脉冲多普勒显示肿瘤内血流频谱为动脉样频谱。结论随着对原发性输尿管癌认识程度及超声诊断技术的提高,对有血尿及腰背痛的患者,超声检查要系统全面,尤其结合CDFI及经阴道或经直肠超声检查诊断更有意义。

Objective To improve the initial ultrasonographie detection aeeuraev of primary ureteral cancers. Methods A total of 51 cases with primary ureteral cancer were initially detected by abdominal ultrasonography, endosonography and three-dimensional ultrasonography. The results were proved by pathologT and retrospectively analysed. Results The sonography detected 24 cases with ureteral tumour; 1 with swollen lymph node near the iliac vessel, 2 with retroperitoneal tumor ; 1 with uterine adnexal tumor; 5 with bladder tumour and 2 with ureteral lithiasis . Compared with pathology, the correct diagnostic rate was 47.1% （24/51 ） , misdiagnoscd rate was 21.5 % （ 11/51 ） and missed diagnosis rate 31.4% （ 16/51 ）. The turnout located in the ureter showed a homogeneous low echo a little stronger than that of hydronephrosis . The turnout was distributed along the ureteral axis and its axial diameter was larger than that of its anteroposterior. The tumour which located at the end of the ureter and extruded to the bladder, showed medium and irregular echoes. The sonograms showed more clearer if the lump located at the upper and lower ureter especially invasing into the inner wall of the bladder. Ultrasound was difficult to demonstrate the middle and lower ureter. For the suspected lumps at the lower ureter, detection can be done via transvaginal or transreetal endosonography. We should reconstruct three-dimensional structure to reveal the tumor position and surroundings when clear images were captured. The blood flow detected by CDFI appeared abundant, skep- like, branch-like or stick-like shape. The pulsed Doppler demonstrated arterial flows. Conclusions Because of the improvement of the related knowledge and advancement of equipments, the uhrasonographic detection should be routinely applied for the patients with blood urine and lumbodorsal pain . Combined with CDFI and endosonographic detection, we may get more reliable results for diagnosis.