非加压法静脉肾盂造影方法的评价与临床价值

Evaluation and clinical value of nonpressurized intravenous pyelography

目的:回顾性研究获取高质量的静脉肾盂造影(Intravenous pyelography,IVP)影像资料的最佳技术方法以保障全面、准确的诊断。方法:研究组为非加压法IVP300例,其中头低足高位100例,动态头低足高体位100例、低张常规位100例;100例常规加压法VIP作为对照组。由高年资技术人员与副高级职称医生对两组显影效果、图像质量、诊断要求进行评价,相关数据进行统计学处理。结果:研究组300例因无加压痛苦,全部顺利完成符合诊断要求的VIP检查;对照组100例因年老、体弱、肥胖、下腹部病变等不能承受腹部加压而于检查中途解压以至于无法达到诊断要求者达5%(5/100)、图像欠佳影响诊断者13%(13/100)。研究组300例,肾盂肾盏、肾盂输尿管连接部和输尿管全程清晰显示为93.7%(281/300),显示欠佳但达到诊断要求6.3%(19/300)。研究组因诊断要求需改变体位多角度摄片以显示病变细节11.7%(35/300);对照组需要多角度摄片而无法完成7%(7/100)。尿路全程显影率:研究组93.7%(281/300),对照组43%(43/100),二者差异具有显著性检验意义(P<0.01)。结论:非加压法IVP具有免除加压痛苦、清晰显示解剖、病变细节、尿路全程显示率明显高于加压法等优点,优于加压法。

Objective：To study the best technological methods for high quality intravenous pyelography（IVP）. Methods： 300 patients undergoing nonpressurized IVP were chosen as study group; 100 patients undergoing routine pressurized IVP were chosen as control group. The visualization effect and imaging quality of two groups were evaluated by senior technologist and doctor, and related data were processed statistically. Results： All of the 300 patients in the study group completed the examination successfully and painlessly. Of the 100 patients in the control group, 5%（ 5/100 ） did not meet the diagnostic requirements , because they could not stand the pressurization because of old age, weakness, obesity and pelvis lesions,and had to be decompressed; 13%（13/100） cases with poor image quality influenced the diagnostic results. In the study group, 93.7%（281/300） cases were with clear visualization of pelvis and renal calices, conjunction of pelvis and the ureter, and the whole course of ureter. The remaining 6.3%（ 19/300）were with not-very-well visualization of the urinary system but met the diagnostic requirements. 11.7%（35/300） patients in the study group needed to change position to gain multi-angle photographs for visualization of the details of the lesions, while 7% （7/100） patients in the control group needed multi-angle photographs but could not complete the examination. There was a significant difference in the whole course visualization of the urinary system （P〈0.01, 93.7% in the study group vs. 43% in the control group ）. Conclusion： Non-pressurized IVP is better than pressurized IVP with advantage of painlessness, clear visualization of the anatomy of the whole course of the urinary system and details of lesions.