儿童膀胱输尿管反流行超声尿路造影病例系列报告

doi:10.3969/j.issn.1673-5501.2019.05.012

摘要/Abstract

摘要： 目的探讨超声尿路造影(CeVUS)对诊断和随访膀胱输尿管反流(VUR)的价值。方法选择复旦大学附属儿科医院2018年9月27日至2019年5月10日收治的VUR高危患儿,利用六氟化硫微泡造影剂经膀胱内给药,进行CeVUS检查。总结CeVUS的检查结果,并结合临床特点进行分析。结果 50例患儿行CeVUS检查,男21例(42%,孤立肾2例),女29例(孤立肾1例),中位年龄25.0(2.3~99)月。①首次接受CeVUS检查者26例(50个PUUs),阳性15例(57.7%),其中低级别反流6例(40.0%),中、高级别反流9例(60.0%)。21/50个PUUs存在VUR,中、高级别反流14个(66.7%)。②24例(47个PUUs)既往行MCU,随访行CeVUS检查仍有24/47个(51.1%)PUUs 存在反流。反流好转患儿CeVUS与MCU检查间隔时间明显长于随访恶化或相仿患儿的随访时间(19.1月 vs 12.2月,P=0.02)。③在接受CeVUS的患儿中,14例已通过前期B超等检查发现存在除VUR以外的泌尿系发育畸形或有肾外表现。9例在完善CeVUS检查前已行MCU检查提示存在VUR。未发现造影剂相关的不良事件。结论 CeVUS可用于VUR的诊断和随访。

关键词: 膀胱输尿管反流, 超声尿路造影, 儿童

Abstract: Objective To evaluate the value of contrast-enhanced voiding urosonography in diagnosis and follow-up in pediatric vesicoureteral reflux(VUR).Methods Children with high risk of VUR admitted to Children's hospital of Fudan University between September 2018 and May 2019 were given Sulfur Hexafluoride Microbubbles (Sonovue) through bladder for CeVUS. The results of CeVUS examination combined with the clinical characteristics of children were analyzed.Results A total of 50 children received CeVUS examination, including 21 males (42%, 2 with isolated kidney) and 29 females (58%, 1 with isolated kidney).The median age of them is 25.0 (2.3~99.0) months. ①26 patients (50 PUUs) received CeVUS examination for the first time, and 15 /26 patients (57.7%) had VUR, among which 6 patients (23.1%) were low grade and 9 patients (34.6%) were high grade.VUR exists in 21/50 PUUs, and middle and high level (Ⅲ-Ⅴ) reflux accounted for 66.67%.② 24 patients(47 PUUs) had received MCU before and 24/47 (51.1%) PUUs still had reflux during the follow-up CeVUS examination.The follow-up interval between CeVUS and MCU in children with improved reflux was significantly longer than the time of children with worsening or similar reflux (19.1 month vs 12.2 months, P=0.02). ③ Among the children who received CeVUS, 14 cases have been found to have urinary or other malformations but VUR through early B-ultrasound and other examinations. In 9 cases, MCU examination indicated the presence of VUR before the CeVUS examination was completed.Conclusion Since CeVUS has no radiation, it can be used for diagnosis and follow-up of VUR. For follow-up patients, the frequency of examinations can be appropriately prolonged.

Key words: Children, Contrast enhanced voiding urosonography, Vesicoureteral reflux

张致庆, 沈茜, 何丽莉, 孙颖华, 徐虹. 儿童膀胱输尿管反流行超声尿路造影病例系列报告[J]. 中国循证儿科杂志, 2019, 14(5): 380-383.

ZHANG Zhi-qing, SHEN Qian, HE Li-li, SUN Ying-hua, XU Hong. The value of contrast-enhanced voiding urosonography in the diagnosis and follow-up in pediatric vesicoureteral reflux[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(5): 380-383.

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