泌尿系造影诊断下腔静脉后输尿管.docVIP

泌尿系造影诊断下腔静脉后输尿管【摘要】 目的 提高下腔静脉后输尿管病的诊治水平。 方法 回顾性分析7例经手术证实的下腔静脉后输尿管,诊断主要依据静脉尿路造影 (IVU)、逆行尿路造影(RP)、B超及CT检查。结果 经IVU、RP、B超及CT检查,所有病例在术前均获得明确诊断;IVU显示5例上段输尿管扩张呈典型的反“J”状, 2例呈“锥形”改变;RP显示输尿管导管呈“S”形;CT扫描显示下腔静脉与腹主动脉间圆点状输尿管充盈影。结论 泌尿系造影检查是诊断下腔静脉后输尿管的可靠方法。 【关键词】 尿路造影术;输尿管疾病 Diagnosis of retrocaval ureter ZHANG Zhi-qiang, DENG Li-xin, WANG Hong-zhi,et al.Department of radiology,Heilongjiang Forest general Hospital,Harebin 150040,China 【Abstract】 Objective To evaluate the diagnostic value and limitation of urography in retrocaval ureter.Methods 7 cases with retrocaval ureter confirmed by operation were retrospectively reviewed. Intravenous urography(IVU) and retrograde yelography (RP) were performed in all cases. Results All cases were definitely diagnosed by urography、ultrosonography and computed tomography before operation. On IVU, the dilation of the right pelvicalyceal system and upper ureter formed a characteristic reversed J-shape in 10 cases and tapering in 2 cases.On RP, the catheter presented S-shaped appearance. CT scan revealed opacification of ureter posterior to inferior vena cava, and scan at lower level revealed the ureter medial to vena cava and just anterior to vertebral body. Conclusion Urography is a reliable method for the diagnosis of retrocaval ureter. 【Key words】 Urography;Ureteral diseases 下腔静脉(IVC)后输尿管是少见的先天性畸形。笔者搜集了我院2000～2009年间收治的7例患者,均经手术证实。现结合文献报告如下。 1 材料与方法 本组男4例,女3例, 6例患者有不同程度的右腰痛、不适和血尿,其中间歇性肉眼血尿5例,镜下血尿1例,2例伴有高血压,其中1例为双侧肾动脉狭窄,合并肾、输尿管结石5例。本组7例均行静脉尿路造影(IVU)和逆行尿路造影(RP), 2例行CT检查。 2 结果 本组行IVU 7例,5例中、重度积水,2例轻度积水,5例上段输尿管扩张呈典型的反“J”状;2例呈“锥形”改变,3例可见扩张段输尿管、腔静脉后输尿管和下行输尿管显影,呈横“S”形,扩张段输尿管横径自1.6～3.2 cm不等,移行段渐细至突然中断。 本组行RP 7例,均显示全程输尿管行径与腔静脉后输尿管位置和宽径,7例中下段输尿管自出腔静脉,由上而下呈反“S”形沿椎体右1/2中部自然迂曲下行,2例“锥形”改变者,则于右侧横突中外部垂直下行入膀胱,腔静脉后输尿管显影浅淡不一,宽度自0.2～0.4 cm不等,其位置于L3下缘至L?3、4?间隙水平。 CT增强延时扫描,1例反“J”状扩张的输尿管横断面于腰大肌旁呈“8”字形。1例无扭搭的扩张输尿管呈一单个圆形影。IVC与腹主动脉间见圆点状输尿管影,狭窄前输尿管呈滴形或梭形扩张。本组7例B超检查,其中5例提示腔静脉后输尿管。 3 讨论 3.1 下腔静脉后输尿管病临床特点 IVC后输尿管是下腔静脉发育异常所致的一种少见的先天性畸