CT尿路造影成像后行静脉肾孟造影对输尿管结石的诊断效果及ESWL术中结石定位分析

Values of intravenous pyelography in the diagnosis of ureteral calculi and intraoperative location of ESWL after CT urography

目的探讨CT尿路造影成像(CTU)后行静脉肾孟造影(IVP)对输尿管结石的诊断效果,及体外冲击波碎石术(ESWL)术中结石定位分析。方法选取2017年1月至12月B超检查结果示输尿管结石准备行ESWL者54例,均先于DR摄片室拍摄腹部X线平片(KUB),然后在CT室行CTU并三维重建,CTU检查结束后立即至造影室行IVP检查。记录诊断结石、梗阻积液及输尿管显影情况。结果 CTU诊断阳性结石50例,结石诊断率为92. 60%,梗阻积液诊断率为88. 89%,输尿管显影率为75. 93%;CTU后KUB+IVP检查诊断阳性结石38例,阴性结石8例,合计结石诊断率为85. 19%,CTU后KUB+IVP输尿管显影率高于CTU(P <0.05)。CTU诊断中,部分患者输尿管显影延迟导致三维重建失败,而在延时IVP中相当一部分患者可见梗阻以上输尿管扩张显影。结论 CTU较IVP能更精确诊断输尿管结石,但对于输尿管显影延迟者,透视下IVP作为补充可依据个体情况安排时间复查,协助ESWL术中结石定位。

Objective To investigate the value of fluoroscopic intravenous pyelography (IVP) in the diagnosis of ureteral calculi and intraoperative location of extracorporeal shock wave lithotripsy (ESWL) after 128 - slice spiral CT urography ( CTU ). Methods A total of 54 patients indicated by B-ultrasound with ureteral calculi who prepared to undergo ESWL from January 2017 to December 2017 were selected. After photographing of abdominal plain film ( KUB), the patients underwent CT urography and three-dimensional reconstruction in the CT room. The intravenous pyelography was performed under the fluoroscopy of digital gastrointestinal diagnosis machine. The diagnosis of stones, obstruction effusion and ureteral development were recorded. Results There were 50 cases with positive calculi diagnosed by CTU. The diagnosis rate, rate of obstruction and hydrops, ureteral development rate were 92.60%, 88.89% and 75.93%, respectively. There were 38 cases with positive calculi diagnosed by KUB with IVP after CTU, 8 cases with negative calculi. The total diagnosis rate, rate of obstruction and hydrops, ureteral development rate was 85. 19%. The Post-CTU KUB + IVP ureteral development rate was higher than CTU ( P < 0.05 ). In CTU , the delayed ureteral development in some patients lead to failure of three-dimensional reconstruction. In delayed IVP, there were ureteral dilatation development in quite a few patients above the obstruction. Conclusions CTU can diagnose ureteral calculi more accurately than IVP, but for those with delayed ureteral development, IVP can be used as a supplement to arrange time review according to individual circumstances. The latter is helpful for the intraoperative location of ESWL.