腎盞憩室結石之超音波診斷與臨床應用

雖然超音波掃描已廣泛地應用於腎臟疾病的篩檢與診斷，但關於腎盞憩室結石（calculi in renal calyceal diverticulum）的超音波掃描在文獻上只有少數報告。本文研究的目的在分析腎盞憩室結石的超音波表徵，以期第一線診斷腎盞憩室結石。從1985年3月至1992年3月共7年間，我們收集了23例腎盞憩室結石的病例，每一例均接受過超音波檢查，且經靜脈注射尿路攝影或手術証實。我們回顧其超音波表現，加以分型，可分為：（1）A型：腎實質（renal parenchyma）上囊狀結構（cystic structure）內，可隨姿勢改變而轉向靠地側（dependent part）的新月狀（crescent shape）高回音結石（echogenic calculi），其後伴隨遠端音影（acoustic shadowing），約65％（15/23）；（2）B型：腎實質囊狀結構內形成結石－液體平面（stone-fluid level），約22％（5/23）；（3）C型：腎實質內鈣化結構合併遠端音影，但結石無法隨病患姿勢改變而滾動，佔13％（3/23）。根據我們分析這些病例的經驗中，超音波對於腎盞憩室結石的診斷與臨床應用有下列的價值：（1）分辨右上腹部鈣化的正確來源；（2）長期追蹤腎盞憩室結石，確定有無併發症發生；（3）偵測透X光射線（radiolucent）結石，及靜脈注射尿路攝影（intravenous urography, IVU）不顯影的憩室；（4）於手術中對腎盞憩室正確的導引及定位。

關鍵字

腎盞憩室；結石；超音波診斷；超音波導引；超音波定位

並列摘要

Sonography has become established as an important diagnostic modality in the evaluation of renal disease. However, the use of sonography for diagnosis of calculi in renal calyceal diverticulum has rarely been discussed in the literature to date. The purpose of this study is to analyse the sonographic appearances of calculi in renal calyceal diverticulum as a first line diagnosis. This study was based on 23 cases of calculi in renal calyceal diverticulum who underwent sonographic evaluation from March 1985 to March 1992. All cases were verified by intravenous urography and/or surgical intervention. The sonographic appearances are classified as: Type A, with the gravity dependent echogenic calculi within a cystic lesion in the renal parenchyma, and the calculi associated with a distal acoustic shadowing. Type B, calculi layering as stone-fluid level within a cystic lesion of the renal parenchyma. Type C, calculi presenting as parenchymal calcification. The sonographic differential diagnosis and its clinical applications are discussed in addition.

並列關鍵字

Calyceal diverticulum ； Calculus ； Sonography ； Sonoguiding ； Sonographic localization

國際替代計量

腎盞憩室結石之超音波診斷與臨床應用

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