CT尿路成像和静脉肾盂造影在泌尿系统疾病诊断中的比较研究

Comparison between intravenous urography and computed tomography urography in diagnosing urological diseases

目的 比较CT尿路成像（CTU）和静脉肾盂造影（IVU）诊断泌尿系统疾病的准确率、放射线辐射剂量、检查费用等。探讨临床上CTU能否取代IVU。方法 共108例患者行IVU和CTU检查,男性78例,女性30例,平均年龄42（18~71）岁。结石54例、肾囊肿3例、各种原因的输尿管梗阻16例、结核3例、腹膜后纤维化2例、膀胱癌16例、肾癌2例、输尿管癌2例、盆腔肿物2例、肾输尿管畸形3例、肾盂癌3例、正常3例。以临床病理学诊断为标准,判断IVU和CTU的诊断准确率。结果 CTU诊断准确率为90.43%,IVP诊断准确率为49.69%（P〈0.05）。其中结石的诊断准确率为CTU 100%,IVP 78.40%;肾囊肿CTU 100%,IVP 11.11%;除结石肿瘤外的输尿管梗阻CTU 77.08%,IVP 8.33%;结核CTU 77.78%,IVP 11.11%;腹膜后纤维化CTU 100%,IVP 33.33%;膀胱癌CTU 89.58%,IVP 22.92%;肾癌CTU 100%,IVP33.33%;输尿管癌CTU83.33%,IVP50%;盆腔肿物CTU 100%,IVP 0%;肾盂癌CTU77.78%,IVP77.78%;肾输尿管畸形CTU83.33%,IVP 50%;正常CTU100%,IVP 88.89%。检查费IVU约600元,CTU约1600元。结论 CTU的诊断准确率显著高于IVU,但由于放射线辐射剂量远高于IVU、设备昂贵且检查费用高于IVU,故临床上CTU不能完全替代IVU。

Objective To compare computed tomography urography （CTU） and intravenous urography （IVU） in the di- agnosis of urological diseases. Methods A total of 108 patients including 78 males and 30 females underwent IVU and CTU. The patients＇ average age was 42 （18--71） yeas. Of all cases, 54 were urolithiasis, 3 were renal cyst, 16 were urinary obstruc- tion, 3 were tuberculosis, 2 were retroperitoneal fibrosis, 16 were bladder tumor, 2 were renal tumor, 2 were ureteral cancer, 2 were pelvic cancer, 3 were urinary abnormality, 3 were renal pelvic carcinoma, and 3 were normal. Results The accuracy of diagnosis was 90.43% in the CTU group and 49.69% in the IVU group （P〈0.05）. The accuracy of diagnosing urolithiasis, renal cyst, urinary obstruction, tuberculosis, retroperitoneal fibrosis, bladder cancer, ureteral cancer, pelvic neoplasm, pelvic cancer, urinary abnormality, and normal cases, was 100% vs. 78.4%, 100% vs. 11.11%, 77.08% vs. 8.33%, 77.78% vs. 11.11%, 100% vs. 33.33%, 89.58% vs. 22.92%, 83.33% vs. 50%, 100% vs. 0%, 77.78% vs. 77.78%, 83.33% vs. 50 %, 100 % vs. 88.89 %, respectively, in the CTU group and the IVP group. The dose of radiation was 75--150 mSv in CTU group and 0.4--0.8 mSv in IVP group. The cost of CTU was 1 600 Yuan and the cost of IVP was 600 Yuan. Conclusion CTU can provide more accurate diagnosis than IVP, but it has more dose of radiation and higher cost than IVP. Therefore, CTU cannot replace IVP as a routine examination in most cases.