CT尿路成像和IVU检查诊断泌尿系统疾病的比较研究

Comparison between intravenous urography and computed tomography urography in diagnosing disease of urology

目的 比较CT尿路成像（CTU）和IVU检查诊断泌尿系统疾病的准确率,探讨临床上CTU取代IVU的可能性.方法 CTU检查泌尿系统疾病患者165例.男111例,女54例.平均年龄42（18～71）岁.肾输尿管结石75例、肾盂输尿管连接处畸形30例、膀胱癌30例、肾盂旁囊肿和肾盂源性囊肿15例、双侧巨输尿管症9例、肾盂输尿管肿瘤6例.行IVU和CTU检查78例,行CTU、IVU和逆行肾盂输尿管造影（RP）检查12例,行CTU和RP检查24例,仅行CTU检查51例.结果 165例患者中,CTU和IVU检查诊断准确率分别为94.5%（156/165）、46.7%（42/90）,二者比较差异有统计学意义（P＜0.01）.二者诊断上尿路结石准确率分别为100.0%（75/75）、78.6%（33/42）（P＜0.05）;CTU诊断肾盂输尿管连接部畸形准确率为90.0%（27/30）,IVU检查15例仅能显示肾盂积水;CTU诊断膀胱癌准确率为100.0%（30/30）,IVU检查12例,发现膀胱内充盈缺损9例（75%）（P〉0.05）CTU诊断肾盂旁囊肿和肾盂源性囊肿准确率为80.0%（12/15）,IVU检查10例无法显示囊肿范围与大小;CTU诊断双侧巨输尿管症准确率为100.0%（9/9）,IVU检查6例仅发现患侧肾脏不显影或肾盂积水;CTU诊断输尿管恶性肿瘤准确率为100%（6/6）,IVU检查5例仅发现患侧肾脏不显影或肾盂积水.CTU和IVU对上尿路梗阻性病变者患侧和（或）梗阻远端显示率分别为79.4%（81/102）、25.0%（15/60）,二者比较差异有统计学意义（P＜0.01）.CTU、IVU检查时间分别为（18.9±8.4）、（67.1±26.7）min,二者比较差异有统计学意义（P＜0.01）.结论 CTU检查在诊断泌尿系统疾病准确率、了解病变周围组织情况以及对梗阻远端尿路显示率方面明显优于IVU检查,在大部分情况下可以取代IVU检查成为常规方法之一.

Objective The purpose of this study was to evaluate computed tomography urography （CTU） and compared with conventional intravenous urography （IVU） in diagnosis of urological disease. Methods One hundred and sixty-five patients with 111 males and 54 females underwent CTU urography including 78 cases underwent IVU were reviewed in this study. There were 12 cases underwent retrograde pyelography. There were 75 cases of nephrolithiasis and ureterolithiasis, 30 cases of ureteropelvic junction obstruction （UPJO）, 30 cases of bladder cancer, 15 cases of pyelogenic cyst and parapelvic cyst, 9 cases of megaloureter and 6 cases of cancer in pelvis and ureter. Results The accuracy of diagnosis was 94.5% （156/165） in CTU group and 46.7% （42/90） in IVU group.The accuracy of diagnosis was 100.0% （75/75）of nephrolithiasis and ureterolith in CTU group and 78. 6%（33/42）in IVU group, 90.0% （27/30） of UPJO in CTU group, 100.0% （30/30） of bladder cancer in CTU group and 75.0%（9/12）in IVU group, 80.0%（12/15）of pyelogenic cyst and parapelvic cyst in CTU group, 100.0% （9/9）of megaloureter in CTU group, 100.0% （6/6）of cancer in pelvis and ureter in CT group. The displayed rate of the distal end of stenosis and obstruction was 79.4%（81/102）in CTU group and 25.0%（15/60）in IVU group. The examination time was （18.9±8.4）min in CTU group and （67.1±26.7）min in IVU group. Conclusion The CTU can provide more information than conventional IVU and can replace the IVU as routine examination in most cases.