Urinary Tract Obstrction泌尿系梗阻-wangzhihua20140515.pptx
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1、泌尿系梗阻泌尿系梗阻Urinary Tract ObstructionZhihua Wang M.D. Ph.D.Department of UrologyTongji HospitalIntruductionuA wide variety of pathological processes, intrinsic and extrinsic to the urinary system, can make the flow of urine obstructed, then produce proximal urinary tract dialation (由于泌尿系统本身及其周围由于泌尿系统本
2、身及其周围的许多疾病,造成尿液排出障碍,引起梗阻近的许多疾病,造成尿液排出障碍,引起梗阻近侧端尿路扩张积水侧端尿路扩张积水)uClassification:Classification: Obstruction to urinary flow can occur anywhere from the kidneys to the urethral meatus (尿道口). uUpper urinary tract obstruction: kidney (肾脏), ureter (输尿管)uLower urinary tract obstruction: bladder (膀胱), ureth
3、ra (尿道)EtiologyEtiologyqUpper urinary tract obstruction may Upper urinary tract obstruction may be associated with the followingbe associated with the following上尿路上尿路梗阻常见病因梗阻常见病因: : lUreteropelvic junction obstruction (UPJO, 肾盂输尿管连接处狭窄), Calculi (结石), Inflammation or Tuberculosis (炎症或结核), Ureterocel
4、e (输尿管囊肿), Retrocaval ureter (腔静脉后输尿管), Retroperitoneal tumor (腹膜后肿瘤), et al qLower urinary tract obstructionLower urinary tract obstruction 下尿路梗阻常见病因下尿路梗阻常见病因lBladder:bladder outlet obstruction include benign prostate hyperplasia (BPH, 良性前列腺增生), cancer of prostate or bladder, neurogenic voiding dys
5、function (神经原性排尿功能障碍diabetes mellitus, spinal cord disease, multiple sclerosis, Parkinson disease), et allUrethra:Stricture(狭窄), Calculi(结石), Tumor, et al Pathophysiology 病理生理病理生理q基本病理改变是梗阻以上压力增高,尿路扩张梗阻以上压力增高,尿路扩张积水积水,若长时间不能解除,最终导致肾积水肾积水和肾功能衰竭肾功能衰竭。Pathophysiology 病理生理病理生理qEssential pathological pro
6、cess: Essential pathological process: Obstruction of the urinary tract at any level will make elevation of intraluminal ureteral pressure and proximal urinary tract dropsy, if the obstrction can not be relieved, result in hydronephrosis and renal failure eventuallylHydronephrosis. (ureteropelvic jun
7、ction stenosis)Including:lUrinary dilation above the obstruction(梗阻以上部位尿路扩张)lRenal blood flow progressively falls(肾血流逐渐减少)lImpaired glomerular filtration(肾小球滤过受损)lThe ability of condensation decrease(浓缩功能下降)lImpaired urine acidification(酸化功能受损)Complications 并发症并发症lInfection(感染感染): including cystitis
8、 (bladder infection), pyelonephritis (kidney infection), abscess formation, and urosepsis lCalculi(结石结石): because of urinary flow retention and infection 肾积水(肾积水(hydronephrosis)DefinitionThe term hydronephrosis is derived from hydro (from the Greek hydor, “water”), nephros (Greek “kidney”), and osis
9、 (“condition”) and is generally defined as dilatation of the renal pelvis and calyces resulting from obstruction to the flow of urine.肾积水(肾积水(hydronephrosis)概念: 尿液从肾盂排出受阻,蓄积后肾内压力增高,肾盂肾盏扩张,肾实质萎缩,功能减退,称为肾积水。Clinical ManifestationFManifestation of primary disease which induced obstrction(导致梗阻的原发病表现):Ca
10、lculi, Tumor, Inflammation, Tuberculosis, BPH, et alFManifestation of hydronephrosis(肾积水本身表现):low back vague pain, abdominal massThe clinical presentation of urinary tract obstruction varies with the causes, location, duration, and degree of obstruction. Clinical ManifestationFManifestation of Renal
11、 insufficiency(肾功能损害表现):anaemia, hypodynamia, anepithymiaFManifestation of complications of hydronephrosis(肾积水并发症表现):ague, hyperthermy, low back pain, urinary tract irritationDiagnosis & Clinical evaluation诊断及临床评估诊断及临床评估FDiagnosis of hydronephrosis(肾积水的诊肾积水的诊断断):by Imaging Studies UltrasonographyInt
12、ravenous pyelography (IVP,静脉肾盂造影)Retrograde pyelography (逆行插管肾盂造影)Computerized tomography (CT) scanMagnetic resonance imaging (MRI)Ultrasonography 超声波检查超声波检查lUltrasonography of the kidneys and bladder is a useful imaging modality as an initial study. It is a noninvasive inexpensive study that does n
13、ot involve radiation exposure or depend on renal function. (初步筛查、无创、廉价等)lIn patients with intravenous pyelography (IVP) dye allergies or elevated creatinine levels, this is a useful source of imaging. (造影剂过敏或肾功能不全患者)Ultrasonography 超声波检查超声波检查lUltrasonography is sensitive in revealing renal parenchym
14、al masses, hydronephrosis, distended bladder, and renal calculi.(对于诊断肾实质肿块、肾积水、扩张的膀胱、肾结石等敏感性高) lIn adults, if the ultrasonography findings are abnormal in any way, additional imaging is usually recommended.(若超声波检查异常,常需要进一步进行其他影像学检查)Intravenous Pyelography(IVP 静脉肾盂造影静脉肾盂造影)lIt provides both anatomica
15、l and functional information. IVP能提供解剖和功能两方面的信息 lDelayed calyceal filling, delayed contrast excretion, and dilation of the urinary tract proximal to the point of obstruction characterize obstruction. IVP上梗阻表现为造影剂分泌延迟、肾盏显影延迟、梗阻部位以上尿路扩张lIVP is superior to CT scan in revealing small urothelial upper tr
16、act lesions. IVP 对于微小的尿路上皮病变优于CTIntravenous Pyelography(IVP 静脉肾盂造影静脉肾盂造影)lIf an IVP is inadequate, retrograde pyelography can be performed to completely visualize the renal pelvis or ureter. 如果IVP获得的信息不够充分,可以选择逆行插管造影充分显示肾盂和输尿管lPatients with IVP dye allergy can not undergo this test. 造影剂过敏者不能进行此项检查IV
17、PCTUMRI(MRU)Retrograde PyelographylRetrograde pyelography is performed in the operating room with a cystoscope in the bladder. 逆行插管造影是在膀胱镜下进行lRadiographic dye is injected into each ureteral orifice. Then, with the use of fluoroscopy, any ureteral or renal pelvis filling defects or abnormalities can
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