经皮肾细针穿刺美蓝试验诊断输尿管瘘的应用价值

Diagnosis of Ureteral Fistula Via Percutaneous Fine Needle Methyl Blue Infusion Test

目的:探讨经皮肾细针穿刺美蓝试验在输尿管瘘诊断中的应用价值。方法:回顾性分析54例输尿管瘘患者的临床诊断资料:常规先行静脉尿路造影(IVP),部分患者同时行增强CT,然后所有患者均行经皮肾细针穿刺美蓝试验。结果:42例IVP或增强CT提示患侧输尿管瘘,其中1例虽IVP和增强CT均提示为左侧输尿管瘘,但经皮肾细针穿刺美蓝试验证实为右侧输尿管瘘。12例患者IVP或增强CT无法判断患侧输尿管瘘,其中4例肾脏不显影,5例肾脏显影淡,延迟显影仍显示不清,3例上尿路显影良好,但无法区分患侧输尿管瘘。12例IVP显示不清患者通过行经皮肾细针穿刺美蓝试验,均明确诊断为患侧输尿管瘘。IVP诊断准确率为75.9%(41/54),经皮肾细针穿刺美蓝试验为100%(54/54)。所有患者经通畅负压引流、经皮肾穿刺造瘘术尿流改道或二期手术后痊愈。结论:IVP或增强CT是诊断输尿管瘘的有效方法,但存在一定局限性。经皮肾细针穿刺美蓝试验诊断输尿管瘘方法简便,准确率高,无放射性损害,可作为输尿管瘘的常规诊断方法,并可为采用有效的经皮肾造瘘引流治疗输尿管瘘提供重要的指导信息。

Objective：To explore and evaluate the value of percutaneous fine needle methyl blue infusion test in the diagnosis of ureteral fistula. Methods：Clinical data of 54 cases diagnosed as ureteral fistula were reviewed. All patients received intravenous pyelography, some also received computed tomography. Finally, percutaneous fine needle methyl blue infusion test was performed. Results： The lesion site of ureteral fistula was indicated by IVP or contrasted CT in 42 patients. Left ureteral fistula was indicated by IVP and contrasted CT in one case, however, right ureteral fistula was confirmed by percutaneous fine needle methyl blue infusion test. Among the other 12 patients difficult to identify the site of ureteral fistula by IVP or CT, 4 showed nonvisualization of unilateral kidney, 5 showed poor visualization of unilateral kidney, 3 were difficult to identify the site of ureteral fistula, though the upper urinary tract visualization was good. Nevertheless, they were confirmed by percutaneous fine needle methyl blue infusion test. The diagnostic accuracy of IVP was 75.9% （41/54）, while percutaneous fine needle methyl blue infusion test was 100% （54/54）. All patients were cured via unobstructed negative pressure drainage, percutaneous nephrostomy or later surgery. Conclusions：Although intravenous pyelography or computed tomography is a good method for diagnosis of ureteral fistula, it has some limitations. Percutaneous fine needle methyl blue infu- sion test can be a routine method for diagnosis of ureteral fistula, which is easy to do and much more accuracy without x-ray radiation. Furthermore, it directs effective percutaneous nephrostomy to treat the disease.