老年患者上尿路梗阻致肾积水的病因及影像学诊断分析

Analysis of etiology and imaging diagnosis in elderly patients with hydronephrosis induced by upper ureteric obstruction

目的:提高老年人上尿路梗阻的诊断水平.方法:回顾性分析了10a来收治的60岁以上老年上尿路梗阻致肾积水167例的病因及影像学诊断方法,分析了B超、静脉肾盂造影(IVP)、逆行造影和CT对上尿路梗阻的检出、定位及病因的诊断.结果:在本组病例中,肾盂、输尿管结石56例,肾盂、输尿管癌51例;腹膜后转移及盆腔肿瘤19例;输尿管结核12例;输尿管损伤后狭窄10例.B超,IVP,逆行造影和CT对上尿路梗阻检出率分别为98.6%,70.3%,100%,73.5%.定位正确率分别为67.2%,64.3%,100%,81.2%,两者联合检查定位正确率高达100%.病因确诊率分别为72.3%,57.6%,78.2%和83.6%,综合运用B超,IVP,逆行造影和CT联合检查病变部位定位率和病因判断正确率均可达100%.结论:肿瘤和结石是导致老年患者上尿路梗阻的主要病因,对于腰痛,尤其伴有血尿的患者,合理综合地运用三种影像学检查手段,以明确诊断.

AIM： To improve the diagnosis of elderly patients with upper ureteric obstruction. METHODS： The etiology and diagnosis were retrospectively studied in 167 elderly patients aged over 60 years with hydronephrosis in recent 10 years. The diagnosis of detection, location and the cause of urethremphraxis on upper tract were analysed using B-US（B-uhrosound） , IVP（ intravenous pyelography）, retrograde phelography and CT. RESULTS： Of all the patients, 56 patients were diagnosed with ureterolithiasis, 51 with uretric cancer, 19 with pelvic tumor of posterior peritoneum, 12 with ureteric tuberculosis, 10 with ureteral stenosis due to injury, 6 with uretero-pelvic junction obstruction, 6 with ureteric polyp, 4 with ureterocyst, 3 with retroperitoneal fibrosis. The accurate diagnosis rates of B-US, IVP, retrograde phelography and CT were 98.6% ,70.3%, 100% and 73.5% respectively; the accurate location rates of them were 67.2% , 64. 3% , 100% and 81.2% respectively, and it was up to 100% using both methods together. The accurate cause diagnosis rates were 72.3%, 57.6%, 78.2% and 83.6% respectively, and it was up to 100% using them together. CONCLUSION： Ureterolithiasis and tumor contribute greatly to ureteric obstruction in elderly patients with hydronephrosis. Rational use of imaging examination play a decisive role in the diagnosis of elderly patients with hydronephrosis, especially those accompanined with hematuria.