泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值评估

摘要 目的：探讨泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值。方法：选取2018年11月～2021年11月在本院治疗的88例先天性肾积水患儿为研究对象，所有患儿均完善静脉肾盂造影及彩色多普勒超声检查，以病理诊断结果为金标准，对比两种检查方法对小儿先天性肾积水的诊断价值。结果：彩色多普勒超声检查结果显示，肾积水轻度、中度、重度患儿分别为10例、39例、39例，不同病情程度患儿比较，重度组收缩期峰值速度（PSV）、舒张期最小流速（EDV）均低于中度组和轻度组，重度组血流阻力指数（RI）高于中度组和轻度组（P<0.05），但轻度组与中度组PSV、EDV、RI比较差异无统计学意义（P>0.05）。与病理学诊断检查结果对比，彩色多普勒超声对中度、重度先天性肾积水患儿具有较高的诊断效能，其准确度分别为90.91%、93.18%，与病理诊断kappa值分别为0.795、0.862，具有较高的一致性；但对轻度肾积水诊断效能较低，kappa值为0.629，一致性一般。静脉肾盂造影对轻度先天性肾积水患儿具有较高的诊断效能，准确度为96.59%，与病理诊断kappa值为0.824，具有较高的一致性；但对中度、重度肾积水诊断效能较低，kappa值分别为0.583、0.565，一致性一般。彩色多普勒超声联合静脉肾盂造影诊断准确率高达94.32%，明显高于两检查方法单独应用（P<0.05）。结论：不同病情程度的先天性肾积水患儿具有不同超声征象，彩色多普勒超声对中、重度肾积水患儿具有较好的诊断价值，而静脉肾盂造影诊断轻度肾积水患儿的效能较好，将二者联合可提高对先天性肾积水的诊断准确率。

Evaluation of Urography Combined with Color Doppler in the Diagnosis of Congenital Hydronephrosis in Children

ABSTRACT Objective: To investigate the diagnostic value of urography combined with color Doppler in children with congenital hydronephrosis. Methods: A total of 88 children with congenital hydronephrosis treated in our hospital from November 2018 to November 2021 were selected as the study subjects. All children perfectintravenous pyelography and color Doppler ultrasonography, the pathological diagnostic result was used as the gold standard,and the diagnostic value of the two examination methods in children with congenital hydronephrosis was compared. Results: The results of color Doppler ultrasound showed that there were 10, 39 and 39 children with mild, moderate and severe hydronephrosis respectively. Compared with children with different degrees of illness, the peak systolic velocity (PSV) and minimum diastolic velocity (EDV) in the severe group were lower than those in the moderate and mild group, and the blood flow resistance index (RI) in the severe group was higher than those in the moderate and mild group(P<0.05), but there was no significant difference in PSV, EDV and RI between mild group and moderate group (P>0.05). Compared with pathological examination results, color Doppler ultrasonography has a high diagnostic performance for children with moderate and severe congenital hydronephrosis, with an accuracy of 90.91% and 93.18%, respectively, and the kappa values compared with pathological diagnosis were 0.795, 0.862, high concordance; but low diagnostic performance for mild hydronephrosis, with a kappa value of 0.629, the consistency is general.The diagnostic results of intravenous pyelography were mild hydronephrosis in 11 cases, moderate hydronephrosis in 37 cases, and severe hydronep- hrosis in 40 cases; it has high diagnostic efficiency for children with mild congenital hydronephrosis, with an accuracy of 96.59%, and the kappa value compared with pathological diagnosis was 0.824, which has a high consistency; but the diagnostic performance of moderate and severe hydronephrosis is low, and the kappa value distribution were 0.583 and 0.565, and the consistency is general. The diagnostic accuracy of color Doppler ultrasound combined with intravenous pyelography was 94.32%, which was significantly higher than that of the two methods alone(P<0.05). Conclusion: Different degree of condition of children with congenital hydronephrosis with different ultrasonic signs, color Doppler ultrasound examination for medium and severe hydronephrosis in children with good diagnostic value, while intravenous pyelography is more effective in diagnosing children with mild hydronephrosis. The combination of the two can improve the diagnostic accuracy of congenital hydronephrosis.