- 期刊
Is IVP Necessary in Children with Urinary Tract Infection?
泌尿道感染患兒需做靜注腎盂攝影術嗎？
摘要
為瞭解小兒罹患泌尿道感染症者需不需要做靜注腎盂攝影，因此我們做了此前瞻性的研究”自民國78年7月到79年12月，一共有 143 例泌尿道感染(UTI)個案，在證實有UTI後，分別接受腎臟超音波(sonography)、排尿性膀胱尿道攝影(VCUG)及靜注腎盂攝影(IVP)三種檢查，結果有67例被發現有泌尿道的異常。 以這67例做為研究對象，來探討是不是每個UTI病例都要做IVP？由於SONO及VCUG較具不侵襲性，所以以這兩者的結果來決定IVP的需要性。第一種情況是SONO或VCUG有任何不正常的現象才做IVP，則有67例(46.85%,671143)需要做，其中32例在IVP上會有不正常的發現，佔48%(32/67)，但在此種情況下（SONO或VCUG有任何不正常者），有2例雙套輸尿管(DCS)病例沒被查出來，而只靠IVP才查出來的，意即在第一種情況下才做IVP會遺漏了2例DCS病例。可是在這種情況下，143個 UTI 病例中，67個病例必須接受IVP檢查，其中32例不正常，35例是正常，表示這 35 例是多做的。第二種情況是當SONO不正常，或 VCUG 可以看到高度膀胱輸尿管逆流(VUR)才做IVP者，有30例可以發現不正常，佔70%(30/43)，有13例是正常的，表示只有這13例是多做了，比第一種情況，少做了22例。而在第二種情況下（S ONO不正常，或VCUG有高度VUR），有4例DCS病例是無法被查出來，必須靠IVP才能發覺。意即若在第二種情況下才做IVP，會遺漏4例DCS病例。縱使這4病例沒被查出來，以後在長期追蹤下對腎臟也不會有不良的後果。所以在第二種情況下去做IVP，只做43例，就發現有30例不正常，比第一種情況有效益多了。所以，我們建議小兒跡尿道感染症者，在SONO不正常或有高度VUR情況下才需要做IVP。
關鍵字
無資料並列摘要
A prospective study was conducted to determine the role of intravenous pyelography (IVP) in detecting the associated urinary tract anomalies in children with urinary tract infection (UTI). A total of 143 cases with confirmed UTI all received renal sonography (RS), voiding cystourethrography (VCUG) and IVP, to evaluate for G-U tract anomaly. Associated G-U tract anomalies were noted in 67 cases (46.85%). No single method was adequate in detecting all abnormalities. Based on the anomalies detected, we proposed and compared two different conditions in which IVP was required. In condition A, in which IVP was performed when abnormal finding were found in RS or VCUG, 67 of 143 cases with UTI (46.85%, 67/143) were required to have IVP, among them 32 cases yielded positive results and 35 cases negative results. Two cases of duplex collecting system (DCS) were found only on IVP would be completely undetected under this proposed condition. However, when IVP was recommended and performed at the time of high grade VUR in VCUG or any abnormality in RS (condition B), 43 of 143 patients (30%, 43/143) with UTI were required to undergo IVP, yielding abnormal findings in 30 cases (70%, 30/43) and normal findings in 13. This would leave four cases of DCS undetected, including the 2 detectable only by IVP plus 2 more that showed low grade VUR on VCUG. However, these 4 cases would not result in progressive renal damage in long-term follow up. Therefore, we suggest that IVP is indicated in children with UTI only when high grade VUR is noted in VCUG or when there is any abnormal finding in RS in order to determine the need for surgery or other treatment.
延伸閱讀
- 鄒頡龍、邱文祥、王百孚、黃志賢、陳光國、張心湜（1997）。泌尿科：良性無功能腎之後腹腔鏡切除術。台灣醫學，1(1)，124-128。https://doi.org/10.6320/FJM.1997.1(1).20
- Tsai, C. C., Sy, L., Su, C. C., & Han, S. J. (2004). 經皮腎臟栓塞術使用於持續性尿液滲漏病人. 中華放射線醫學雜誌, 29(5), 283-286. https://www.airitilibrary.com/Article/Detail?DocID=10188940-200410-29-5-283-286-a
- Chou, K. C., Chen, K. K., Lin, A. T. L., Chang, Y. H., Wu, H. H. H., Hsu, T. H. S., Chiu, A. W. S., & Chang, L. S. (1996). 利用核子醫學腎臟攝影檢查及逆行性腎盂攝影檢查在診斷上尿路擴張的相關性. 中華民國泌尿科醫學會雜誌, 7(1), 12-16. https://doi.org/10.7024/JUAROC.199603.0012
- Liao, A. C., Lin, V. C., Cheng, T. C., Chiu, A. W., & Lee, Y. H. (2005). 以全腹腔鏡腎臓輸尿管及膀胱袖切除來治療萎縮腎臓的腎盂腫瘤：病例報告及技術面考量. 臺灣泌尿科醫學會雜誌, 16(1), 25-30. https://www.airitilibrary.com/Article/Detail?DocID=10163220-200503-16-1-25-30-a
- Sun, C. C., Chen, K. K., Lin, A. T., Chang, Y. H., Wu, H. H., Hsu, T. H., Chiu, A. W., Huang, W. J., & Chang, L. S. (1997). 評估對於攝護腺肥大患者以靜脈注射腎盂照影及腹部超音波做為手術前常規檢查之經濟效益. 中華民國泌尿科醫學會雜誌, 8(3), 121-125. https://doi.org/10.7024/JUAROC.199709.0121