超声诊断先天性肾旋转异常的方法探讨

doi:10.3969/j.issn.1006-7795.2020.04.026

摘要/Abstract

摘要： 目的探讨先天性肾旋转异常的超声诊断方法，提高肾旋转异常的超声诊断水平。方法回顾性分析2008年10月至2018年10月经超声检查提示肾旋转异常的20例病例，所有病例均经电子计算机断层扫描（computed tomography，CT）或经静脉尿路造影证实。应用超声对旋转异常肾的大小、形态、肾门位置、肾动静脉血流状况进行观察，并建立坐标系法进行分型，与CT或静脉尿路造影进行对照。结果 20例患者均诊断正确。患肾形态不一，肾结构清晰可辨，肾门方向可见异常。本组肾旋转异常分四型：腹侧位型6例，腹中线位型11例，侧位型2例，背侧位型1例。其中4例伴一条副肾动脉，1例伴2条副肾动脉。结论应用超声能敏感显示肾旋转异常的形态并分型，判断血管走形，可以为临床诊疗提供指导。

关键词: 肾旋转异常, 超声, 诊断

Abstract: Objective To explore the diagnostic method of congenital renal malrotation by ultrasound to improve diagnostic accuracy. Methods Totally 20 cases who were collected from October 2008 to October 2018, with renal malrotation indicated by ultrasound and confirmed by computed tomography (CT) or intravenous urography (IVU) were analyzed retrospectively. Ultrasound was used to observe the position, size, morphology and renal vessels of the rotated kidney. The method of coordinate system was developed to classify the renal malrotation, and the results were compared with CT or IVU. Results Renal malrotation were definitely diagnosed in 20 patients by ultrasound. The shape of the kidney was varied, the structure was clear, but the direction of the renal hilum was abnormal. Four types of renal malrotation were observed in this group 6 cases were ventral, 11 were incomplete rotation, 2 were lateral and 1 was dorsal. Among them, 4 cases had one accessory renal artery, 1 case had two accessory renal arteries. Conclusion The ultrasound could sensitively detect the shape and vessels in renal malrotation. It is accurate and effective for the diagnosis of renal malrotation.

Key words: renal malrotation, ultrasound, diagnosis

中图分类号:

R445

马佳, 杨敬春, 吴静, 常莹, 杜岚, 陈述. 超声诊断先天性肾旋转异常的方法探讨[J]. 首都医科大学学报, 2020, 41(4): 647-651.

Ma Jia, Yang Jingchun, Wu Jing, Chang Ying, Du Lan, Chen Shu. Ultrasound diagnosis of congenital renal malrotation[J]. Journal of Capital Medical University, 2020, 41(4): 647-651.

参考文献 14

[1]	Muttarak M,Sriburi T. Congenital renal anomalies detected in adulthood[J].Biomed Imaging Interv J,2012,8(1):e7.
[2]	Patrizi L,Corrado G,Saltari M,et al. Congenital renal malrotation in ovarian cancer surgery:a case report[J]. Gynecol Oncol Case Rep,2012,4:41-43.
[3]	Weyrauch H M.Anomalies of renal rotation[J]. Surg Gynecol,1939,69(16):183-199.
[4]	金奇.超声图像对先天性肾旋转反常的诊断分型的初步探讨[J].海南医学,2005,16(1):58-59.
[5]	颜海标,黄伟华,莫曾南,等.肾旋转不良的临床解剖特点及诊疗对策探讨[J].局解手术杂志,2010,(19)6:506-507.
[6]	杨天香,邵科晶,钱仕良.排尿性膀胱尿道造影筛查儿童原发性膀胱输尿管反流的意义[J].临床误诊误治,2011,24(11):70-71.
[7]	谭书韬,吴斌.妊娠期输尿管结石的外科治疗[J].中国医科大学学报,2017,46(5):453-456.
[8]	Dokucu A I, Yesildal C,Kirecci S L,et al. First case of right malrotated kidney transplantation[J]. Transplant Proc,2018,50(10):3923-3924.
[9]	Güler Y. Renal pelvis stone in reverse kidney:a case report and literature review[J]. Urol Case Rep, 2020,29:101104.
[10]	Nathan H, Glezer I. Right and left accessory renal arteries arising from a common trunk associated with unrotated kidneys[J]. J Urol, 1984,132(1):7-9.
[11]	Cocheteux B,Mounier-Vehier C,Gaxotte V,et al. Rare variations in renal anatomy and blood supply:CT appearances and embryological background. A pictorial essay[J].Eur Radiol,2001,11(5):779-786.
[12]	Patil S T, Meshram M M,Kasote A P. Bilateral malrotation and lobulation of kidney with altered hilar anatomy:a rare congenital variation[J]. Surg Radiol Anat,2011,33(10):941-944
[13]	Singh J, Singh N, Kapoor K,et al. Bilateral malrotation and a congenital pelvic kidney with varied vasculature and altered hilar anatomy[J]. Case Rep Med,2015, 2015:848949.
[14]	Di Giuliano F, Picchi E, Lacchè A, et al. Congenital kidney malformation:Computed tomography and scintigraphy findings of renal reversed rotation.[J]. Radiol Case Rep,2019,14(6):678-682.

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