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目的探讨多层螺旋CT(MSCT)尿路造影(MSCTU)在儿童输尿管异位开口定位诊断中的应用价值。方法对临床证实存在输尿管异位开口并做MSCTU的患儿60例进行回顾性分析,分析MSCTU扫描图像,对输尿管异位开口的诊断及开口部位做出判断,并以临床随访结果(手术结果、膀胱镜检查结果、输尿管逆行插管造影结果)为金标准,计算MSCTU的正确诊断率。结果 MSCTU示:13例单纯输尿管异位开口患儿中1例MSCTU图像上判断为前庭,但异位开口逆行造影显示为阴道部;31例重复肾输尿管异位开口的患儿中,1例左侧重复肾患儿上肾部及下肾部输尿管均扩张积水,MSCTU仅诊断为肾积水,未能显示双输尿管及其开口情况,余30例患儿MSCTU对异位输尿管侧别、开口情况的诊断与随访结果一致。16例输尿管异位开口伴发育不良小肾脏的患儿中1例患儿异位输尿管中度扩张、末端开口较低,MSCTU诊断为膀胱低位开口,但手术证实为输尿管囊肿;另外1例患儿MSCTU显示输尿管未正常开口于膀胱,但异位开口位置显示不明,临床随访结果显示该患儿输尿管异位开口于尿道。从输尿管异位开口位置层面分析,MSCTU正确判断56例,正确率为93.33%(56/60)。结论 MSCTU对输尿管异位开口位置、所属肾段及周围解剖结构的显示具有一定的优势,可以作为儿童输尿管异位开口术前定位诊断的有效方法之一。
Objective To investigate the value of multi-slice spiral CT (MSCTU) in the diagnosis of ureteral ectopic opening in children. Methods Sixty children with clinically confirmed ectopic ureter and MSCTU were retrospectively analyzed. The MSCTU scan images were analyzed and the diagnosis of ureteric ectopic opening and the location of the opening were made. The clinical follow - up results (surgical outcome, Cystoscopy, ureter retrograde intubation angiography results) as the gold standard, calculate the correct diagnosis of MSCTU. Results MSCTU showed that one case of vestibular was diagnosed on one MSCTU image in 13 children with ectopic ureteropectomy but the retrograde ectopic retrograde angiography was vaginal. Of the 31 children who had ectopic ureteropelvic opening, 1 case left Focus on children with Renal Kidney and lower kidney ureter expansion of water, MSCTU diagnosis of hydronephrosis only, failed to show double ureter and its opening, more than 30 cases of MSCTU on the side of the ureter, open The diagnosis of the situation is consistent with the follow-up results. One of 16 children with ureteral ectopic opening and dysplastic small kidney had moderate ectopic ureteral dilatation and low end opening. MSCTU was diagnosed as low urinary bladder opening, but the operation was confirmed as ureteral cyst. In another case, MSCTU showed that the ureter did not open in the bladder, but the position of the ectopic opening was unknown. The clinical follow-up results showed that the ureter was ectopic opened in the urethra. From the ureter ectopic opening position level analysis, MSCTU correct judgment of 56 cases, the correct rate was 93.33% (56/60). Conclusions MSCTU has some advantages for the display of ectopic ureter opening, the renal section and the surrounding anatomical structures, which can be used as an effective method for the diagnosis of ureter ectopic opening.