摘要
目的分析融合肾锥体在人肾中的解剖表现及分布情况,并探讨其B超和CT检查的表现。方法2018年6—9月对武汉大学基础医学院57具尸体108个肾脏标本进行解剖,记录并统计融合肾锥体的分布及解剖学表现。对中组肾盏正常肾柱及融合肾锥体内叶间动脉行HE染色,显微镜下观察两者的血管分布差异。回顾性分析武汉大学人民医院2018年10月至2019年1月收治的112例(共224个肾脏)行B超检查患者的临床资料(B超组),男60例,女52例。年龄16~73岁,平均(39.0±15.1)岁。分析同期收治的另89例(共178个肾脏)行增强CT检查患者的临床资料(CT组),男48例,女41例。年龄23~69岁,平均(45.4±13.6)岁。除外肾积水、鹿角形肾结石、其他肾解剖学异常者(如肾囊肿、肾盂输尿管连接处梗阻、海绵肾、多囊肾、马蹄肾等)。总结融合肾锥体在B超和CT检查中的影像学特征,分析两种检查方法对融合肾锥体识别情况。结果在108个尸体肾脏标本中,融合肾锥体在上、下组肾盏发生比例分别为68.6%(74/108)、64.8%(70/108),高于中组肾盏的34.3%(37/108),差异有统计学意义(χ2=30.97,P<0.05)。在中组肾盏,肾锥体中度融合比例为39.0%(16/41)、重度融合比例为48.8%(20/41),两个肾锥体融合比例为90.2%(37/41)。HE染色结果显示,正常肾锥体间的肾柱内叶间动脉周围有大量结缔组织包绕,而融合肾锥体内叶间动脉与周围肾锥体分界模糊,缺乏结缔组织保护。临床病例资料分析中,B超组中组肾盏发现融合肾锥体比例为18.8%(42/224),融合肾锥体在普通超声模式下表现为肾髓质内大片梯形或倒三角形低回声区,彩色多普勒模式下可见低回声区内有红蓝相间彩色血流信号。CT组中组肾盏发现融合肾锥体比例为27.5%(49/178),融合肾锥体表现为皮质期肾髓质内较大面积低密度区内出现明显强化的条索状高密度影或尖端指向肾门的高密度楔形影。结论融合肾锥体是人肾常见解剖结构,存在明显血管分布。不同于肾柱内叶间动脉,融合肾锥体内血管缺乏有效结缔组织保护。B超和增强CT检查对融合肾锥体具有一定的识别能力。
Objective To analyze the anatomical structure and distribution of the fused renal pyramid(FRP)in cadaveric kidney,and discuss its appearances by CT and ultrasonic examinations.Methods From June 2018 to September 2018,108 cadaveric kidneys were proceeded for regional anatomy.The distribution and anatomical manifestations of FRP was recorded.The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP.From October 2018 to January 2019,ultrasound imaging data of 112 patients with 224 kidneys were collected,including 60 males and 52 females,age(39.0±15.1),ranging from 16 to 73 years old.The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected,including 48 males and 41 females.Age(45.4±13.6),ranging from 23 to 69 years old.The imaging findings of FRP in ultrasound and enhanced CT was summarized.Results In cadaver kidneys,the proportion of FRP in upper and lower calyces was 68.6%(74/108)and 64.8%(70/108),respectively,higher than that in middle calyces 34.3%(37/108).In the middle group,the incidence of mild fusion was 39.0%(16/41)and severe fusion was 48.8%(20/41).The incidence of fusion of two renal pyramidal structures was 90.2%(37/41).HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear,and the protection of connective tissue was lacking.In Ultrasound,the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode.In ultrasound,the incidence of FRP was 18.8%(42/224).In enhanced CT,the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase.In enhanced CT,the incidence of FRP 27.5%(49/178).Conclusions The FRP is a common structure in human kidney.The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries.Ultrasound and enhanced CT have recognition ability for FRP.
作者
夏煜琦
程帆
饶婷
林方优
余伟民
阮远
宁金卓
杨远婷
宋弯弯
Xia Yuqi;Cheng Fan;Rao Ting;Lin Fangyou;Yu Weimin;Ruan Yuan;Ning Jimhiw;Yang Yuanting;Song Wanwan(department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Ultrasound,Renmin Hospital o f Wuhan University,Wuhan 430060,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第12期895-900,共6页
Chinese Journal of Urology
基金
湖北省卫健委指导性科研项目(WJ2019F158)。
关键词
肾疾病
融合肾锥体
解剖结构
经皮肾镜取石术
超声成像
计算机断层扫描
Kidney diseases
Fused renal pyramid
Anatomical structure
Percutaneous nephrolithotomy
Ultrasound
Computed tomography
