泌尿系造影联合彩色多普勒对...先天性肾积水的诊断价值评估_胡玲玲.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023doi:10.13241/ki.pmb.2023.01.031泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值评估*胡玲玲杨芳谢桢周夙志房莹莹（安徽省儿童医院超声医学科 安徽 合肥 230051）摘要 目的：探讨泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值。方法：选取 2018 年 11 月2021 年 11 月在本院治疗的 88 例先天性肾积水患儿为研究对象，所有患儿均完善静脉肾盂造影及彩色多普勒超声检查，以病理诊断结果为金标准，对比两种检查方法对小儿先天性肾积水的诊断价值。结果：彩色多普勒超声检查结果显示，肾积水轻度、中度、重度患儿分别为 10例、39 例、39 例，不同病情程度患儿比较，重度组收缩期峰值速度（PSV）、舒张期最小流速（EDV）均低于中度组和轻度组，重度组血流阻力指数（RI）高于中度组和轻度组（P0.05）。与病理学诊断检查结果对比，彩色多普勒超声对中度、重度先天性肾积水患儿具有较高的诊断效能，其准确度分别为 90.91%、93.18%，与病理诊断 kappa 值分别为 0.795、0.862，具有较高的一致性；但对轻度肾积水诊断效能较低，kappa 值为 0.629，一致性一般。静脉肾盂造影对轻度先天性肾积水患儿具有较高的诊断效能，准确度为 96.59%，与病理诊断 kappa 值为 0.824，具有较高的一致性；但对中度、重度肾积水诊断效能较低，kappa 值分别为 0.583、0.565，一致性一般。彩色多普勒超声联合静脉肾盂造影诊断准确率高达94.32%，明显高于两检查方法单独应用（P0.05）。结论：不同病情程度的先天性肾积水患儿具有不同超声征象，彩色多普勒超声对中、重度肾积水患儿具有较好的诊断价值，而静脉肾盂造影诊断轻度肾积水患儿的效能较好，将二者联合可提高对先天性肾积水的诊断准确率。关键词：泌尿系造影；彩色多普勒超声；先天性肾积水；诊断价值中图分类号：R692.2文献标识码：A文章编号：1673-6273（2023）01-158-05Evaluation of Urography Combined with Color Doppler in the Diagnosis ofCongenital Hydronephrosis in Children*HU Ling-ling,YANG Fang,XIE Zhen,ZHOU Su-zhi,FANG Ying-ying(Department of Ultrasound Medicine,Anhui Childrens Hospital,Hefei,Anhui,230051,China)ABSTRACT Objective:To investigate the diagnostic value of urography combined with color Doppler in children with congenitalhydronephrosis.Methods:A total of 88 children with congenital hydronephrosis treated in our hospital from November 2018 to Novem-ber 2021 were selected as the study subjects.All children perfectintravenous pyelography and color Doppler ultrasonography,the patho-logical diagnostic result was used as the gold standard,and the diagnostic value of the two examination methods in children with congeni-tal hydronephrosis was compared.Results:The results of color Doppler ultrasound showed that there were 10,39 and 39 children withmild,moderate and severe hydronephrosis respectively.Compared with children with different degrees of illness,the peak systolic velocity(PSV)and minimum diastolic velocity(EDV)in the severe group were lower than those in the moderate and mild group,and the bloodflow resistance index(RI)in the severe group was higher than those in the moderate and mild group(P0.05).Compared with pathological examination results,colorDoppler ultrasonography has a high diagnostic performance for children with moderate and severe congenital hydronephrosis,with anaccuracy of 90.91%and 93.18%,respectively,and the kappa values compared with pathological diagnosis were 0.795,0.862,high con-cordance;but low diagnostic performance for mild hydronephrosis,with a kappa value of 0.629,the consistency is general.The diagnosticresults of intravenous pyelography were mild hydronephrosis in 11 cases,moderate hydronephrosis in 37 cases,and severe hydronep-hrosis in 40 cases;it has high diagnostic efficiency for children with mild congenital hydronephrosis,with an accuracy of 96.59%,and thekappa value compared with pathological diagnosis was 0.824,which has a high consistency;but the diagnostic performance of moderateand severe hydronephrosis is low,and the kappa value distribution were 0.583 and 0.565,and the consistency is general.The diagnosticaccuracy of color Doppler ultrasound combined with intravenous pyelography was 94.32%,which was significantly higher than that ofthe two methods alone(P0.05).Conclusion:Different degree of condition of children with congenital hydronephrosis with differentultrasonic signs,color Doppler ultrasound examination for medium and severe hydronephrosis in children with good diagnostic value,*基金项目：安徽省卫生健康委科研计划项目（2019SEY007）作者简介：胡玲玲（1986-），女，本科，主治医师，从事儿童超声方向的研究，E-mail：（收稿日期：2022-03-23 接受日期：2022-04-18）158现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023while intravenous pyelography is more effective in diagnosing children with mild hydronephrosis.The combination of the two can im-prove the diagnostic accuracy of congenital hydronephrosis.Key words:Urography;Color Doppler ultrasound;Congenital hydronephrosis;Diagnostic valueChinese Library Classification(CLC):R692.2Document code:AArticle ID:1673-6273(2023)01-158-05前言先天性肾积水是小儿常见的外科疾病，主要表现为排尿困难、腰腹部疼痛、恶心呕吐等，多见于男孩，且多发于左侧1。部分先天性肾积水胎儿在产检时可被查出，随着胎龄的增长，生殖系统不断发育成熟，肾积水症状可得到明显改善，但仍有部分患儿在出生后 1 周岁内出现肾积水现象。小儿先天性肾积水的常见病因有肾盂输尿管连接部梗阻（Obstruction of theureteropelvic junction，UPJO）、输尿管末端狭窄、输尿管返流、重复肾重复输尿管积水等，其中 UPJO 最为常见1，长期尿路阻塞将导致肾盂、肾盏外形扩大，同时出现肾组织萎缩现象1。产后肾积水患儿需长期随访肾功能及肾积水稳定情况。早发现、早治疗可有效减少并发症，降低疾病对患儿的影响，从而改善预后。临床上主要采取彩色多普勒超声检查、计算机断层扫描（computed tomography，CT）、静脉肾盂造影检查等进行诊断5,6。其中彩色多普勒超声检查操作简单、无创，且费用低、可重复操作，但其在小儿肾积水的诊断中缺乏具体的诊断标准，易导致漏诊、误诊发生7,8。静脉肾盂造影检查结果不受泌尿系统人为加压因素的影响，准确率性较高，但其结果一定程度上受到肾功能的影响7,8。既往研究表明，单一诊断方法诊断效能较低11。因此，本研究探讨静脉肾盂造影联合彩色多普勒超声对小儿先天性肾积水的诊断价值，以期为临床诊断提供参考思路。1 资料与方法1.1 一般资料选取 2018 年 11 月2021 年 11 月在本院治疗的 88 例先天性肾积水患儿为研究对象。纳入标准：（1）3 d12 岁；（2）均完善彩色多普勒超声及静脉肾盂造影检查；（3）符合手术指征，均经手术或术后证实为肾盂输尿管交界处狭窄；（4）均为单侧肾积水。排除标准：（1）患儿哭闹无法配合完成检查；（2）肾结石、肾肿瘤、肾结核等局部肾脏疾病或肾动脉狭窄者；（3）其他先天性疾病；（4）合并泌尿系感染；（5）临床资料不全；（6）影像学图像不清晰；（7）对比剂过敏者。根据上述标准，共纳入患儿88 例。其中，男 78 例，女 10 例；平均年龄（5.120.68）岁；患病部位：左侧 62 例、右侧 26 例；临床表现：腰腹疼痛 46 例，