【摘要翻译】泌尿系B超对血尿诊断的价值--1000例病例报告

Urinary tract ultrasonography in the evaluation of haematuria--a report of over 1,000 cases.
Datta SN, Allen GM, Evans R, Vaughton KC, Lucas MG.

Department of Urology, Morriston Hospital, Swansea, UK. sndatta@dial.pipex.com

Over a 5-year period, 1007 patients with haematuria were investigated, using a protocol based on ultrasonography as the upper tract imaging modality of choice. Intravenous urography (IVU) was only used in selected individuals, including those patients with bladder cancer suspected on cystoscopy, suspicious or malignant cytology, previous investigation for haematuria, on-going haematuria at the time of their clinic visit, a history of flank pain or hydronephrosis on ultrasonography. Of this series, 840 (83%) had visible haematuria, 158 (15%) had microscopic or chemical haematuria and 9 (0.9%) had unspecified haematuria. A total of 133 bladder transitional cell tumours, 21 renal cell cancers and 2 upper tract transitional cell cancers (TCC) were diagnosed. The sensitivity of ultrasound with respect to bladder cancer was 63% and the specificity 99%. The odds ratio of diagnosing cancer in patients with visible haematuria compared to microscopic or unspecified haematuria was 3.3. No upper tract tumours were missed using this investigational protocol. An ultrasonography-based protocol could miss fewer upper tract TCCs than a standard IVU-based service would miss renal cell cancer. Provided there is no history of flank pain, no malignant cytology, no hydronephrosis and no previously investigated haematuria, IVU could be safely omitted.

PMID: 12092877 [PubMed - indexed for MEDLINE]
泌尿系B超对血尿诊断的价值--1000例病例报告
在5年的时间里，我们用以B超为基础的诊断方法，作为上尿路影像学检查方法，研究了1007个有血尿症状的病人，静脉肾盂造影仅用于以下病人的检查，包括膀胱镜检查怀疑是膀胱癌的病人，尿脱落细胞学检查可疑，既往有血尿症状，在临床随访期间，有进行性血尿加重，以及有腰痛史或B超证实有肾积水的病人。经过我们的研究，1007个病人中，840个病人为肉眼血尿（83%），158个病人为镜下血尿或化学药物性血尿（15%）有9个病人为非特异性血尿（0.9%）。其中，总共有133个膀胱移行细胞癌，21个肾癌和两个上尿路移行细胞癌被利用超声方法正确诊断。对于膀胱癌来说，超声诊断的敏感性是63%，特异性是99%。有肉眼血尿的病人被诊断为癌症的几率是镜下血尿或非特异性血尿的3.3倍。用基于超声的方法没有上尿路肿瘤病例被漏诊。与标准的方法静脉肾盂造影相比较，用超声的方法也很少漏诊上尿路移行细胞癌，而静脉肾盂造影可漏诊肾癌。因此假若，没有腰痛史，没有尿脱落细胞学检查发现恶性细胞，没有肾积水，没有既往血尿史，静脉肾盂造影是完全可以省略的。