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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 127 -130. doi: 10.3877/cma.j.issn.1674-0793.2022.02.008

论著

彩色多普勒超声及计算机断层扫描血管造影术对腹膜后纤维化的诊断价值及随访分析
王慧1, 李梓伦1, 姚陈1, 黄雪玲1, 王深明1, 常光其1,†()   
  1. 1. 510080　广州，中山大学附属第一医院血管外科　血管疾病诊治技术国家地方联合工程实验室　广东省血管疾病诊治工程技术研究中心
  • 收稿日期:2021-12-31 出版日期:2022-04-01
  • 通信作者: 常光其

Value of color doppler ultrasonography and computerized tomography angiography in the diagnosis and follow-up of retroperitoneal fibrosis

Hui Wang1, Zilun Li1, Chen Yao1, Xueling Huang1, Shenming Wang1, Guangqi Chang1,†()   

  1. 1. Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University, National-Local Joint Engineering Laboratory of Vascular Disease Treatment, Guangdong Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou 510080, China
  • Received:2021-12-31 Published:2022-04-01
  • Corresponding author: Guangqi Chang
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王慧, 李梓伦, 姚陈, 黄雪玲, 王深明, 常光其. 彩色多普勒超声及计算机断层扫描血管造影术对腹膜后纤维化的诊断价值及随访分析[J/OL]. 中华普通外科学文献(电子版), 2022, 16(02): 127-130.

Hui Wang, Zilun Li, Chen Yao, Xueling Huang, Shenming Wang, Guangqi Chang. Value of color doppler ultrasonography and computerized tomography angiography in the diagnosis and follow-up of retroperitoneal fibrosis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(02): 127-130.

目的

探讨彩色多普勒超声（CDU）及计算机断层扫描血管造影术（CTA）对腹膜后纤维化（RPF）诊断及随访价值。

方法

回顾性分析2016年1月至2021年12月中山大学附属第一医院收治并诊断为RPF患者18例。对RPF组织回声特点、累及范围、组织厚度进行比较；评估腹主动脉、下腔静脉、髂动脉血流情况以及输尿管是否扩张、有无肾积水等。随访分析患者的治疗效果。

结果

18例患者中，单侧肾积水8例，双侧6例；单侧输尿管扩张5例，双侧8例。17例进行CTA检查，1例仅累及内脏动脉，1例仅累及髂内动脉，15例不同程度累及腹主动脉及髂动脉，下腔静脉被包绕者7例。8例进行CDU检查，1例累及髂内动脉者漏诊，其余患者CDU检查与CTA检查结果一致。两者测量RPF厚度差异无统计学意义。平均随访时间36.2（5~66）个月，其中12例患者随访症状均有明显改善。3例CDU及CTA随访纤维化组织厚度较治疗前明显缩小。

结论

利用CDU及CTA对RPF影像学特点、病变范围、肾脏、输尿管及受累大血管与纤维组织之间的关系病变等进行多角度分析，可以提高对RPF诊断的准确性，避免漏诊及误诊，对RPF的早期诊断、治疗及随访具有重要的意义。

关键词: 超声检查，多普勒，彩色, 腹膜后纤维化, 诊断, 随访, 计算机断层扫描血管造影术
Objective

To study the value of color doppler ultrasonography (CDU) and computerized tomography angiography (CTA) in the diagnosis and follow-up of retroperitoneal fibrosis (RPF).

Methods

A total of 18 cases with RPF who were identified in the First Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2021 were retrospectively analyzed. The echo characteristics of tissue, range, and the thickness of tissue was compared. The patency of abdominal aorta, inferior vena cava, iliac artery and the dilated ureter, hydronephrosis were analyzed. All the patients were followed up and evaluated.

Results

8 cases were with unilateral hydronephrosis, 6 cases with bilateral hydronephrosis. Unilateral ureteral dilation in 5 cases, bilateral ureteral dilation in 8 cases, and 17 cases were detected by CTA. Visceral artery was involved in 1 case. The internal iliac artery was only involved in 1 case. Abdominal aorta and iliac artery were involved in 15 cases. The inferior vena cava was surrounded and compressed by fibrous tissue in 7 cases. 8 cases were detected by CDU. 1 case of internal iliac artery involvement was missed. The results of CDU and CTA were consistent in other patients. There was no significant difference between the comparison for the thickness of tissue which was detected by CTA and CDU. The mean follow-up time was 36.2 (5-66) months. The symptoms of all 12 patients were significantly improved. The scope and thickness of fibrosis involvement in 3 cases were significantly reduced compared with before treatment.

Conclusions

CDU combined with CTA can be used to analyze the imaging characteristics of RPF, the scope of involvement and the relationship between kidney, ureter, blood vessels and fibrous tissue from multiple perspectives, to improve diagnostic accuracy of RPF, and avoid missed diagnosis and misdiagnosis, which is of great significance for the early diagnosis, treatment and follow-up of RPF.

Key words: Ultrasonography, doppler, color, Retroperitoneal fibrosis, Diagnosis, Follow-up, Computerized tomography angiography
图1 CTA及CDU示腹膜后纤维化情况　横断面（A）及冠状面（B）CTA显示不规则均匀回声纤维化组织包绕腹主动脉、双髂总动脉，腹主动脉及双髂动脉内径正常，血流通畅。横切面（C）及纵切面（D）CDU显示腹膜后组织边界不清，不规则均匀回声团块包绕腹主动脉及双髂总动脉，腹主动脉及双髂动脉内径正常，血流通畅
图2 患者保守治疗前后腹膜后纤维组织变化　纵切面（A）及横切面（B）CDU显示腹主动脉周围被不规则均匀回声团块包绕，纤维组织厚度2.7 cm。腹主动脉内径正常，血流通畅。纵切面（C）及横切面（D）CDU显示腹主动脉周围纤维组织厚度明显减少，纤维组织厚度0.9 cm
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