Background: The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation. To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury (AKI) and the postoperative complications. However, the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery (RA).Methods: We reconstructed a three-dimen-sional (3D) vascular model of a patient requiring Fontan palliation. The technique of computational fluid dynamics (CFD) was utilized to explore the changes of RA hemodynamics under different possible blood flow rates. The relationship between the kidney perfusion and hemodynamic characteristics was investigated.Results: The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased. When the flow rate decreased to two-thirds of its baseline, both the pressure of left renal artery (LRA) and the pressure of right renal artery (RRA) dipped below 50%, and the pressure of RRA fell more quickly than that of LRA. Uneven distribution of WSS was observed on the trunk of RA, and the lowest WSS was found at the distal of RA. The average WSS in RA dropped to around 50% as the flow rate reached one-third of its baseline.Conclusions: As a promising approach, CFD can be utilized to quantitatively evaluate the hemodynamic char-acteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function, to help rea-lize better prognosis for the patients with Fontan palliation.

目的:利用计算流体动力学探讨Fontan术后肾血流动力学变化,以辅助临床实现早期监测.方法:基于医学影像数据三维重建肾动脉分析Fontan手术前后不同时刻肾血流动力学参数差异.结果:肾动脉阻力指数及压力阶差在Fontan术后3 h较术前均增高,右肾动脉在术后3 d前均为高速流动,且术后左、右肾动脉血流动力学并未呈一致性改变.结论:计算流体动力学技术结合多普勒超声检查可为临床Fontan手术患儿早期异常肾血流动力学监测提供综合全面的评估,有助于患儿围手术期管理,改善预后.

目的 先天性门-体静脉分流(CPSS)是一种罕见的畸形.影像学检查是诊断CPSS的重要手段.本文旨在探讨彩色多普勒超声在儿童先天性门-体静脉分流的表现及诊断价值.方法 选取我院收治CPSS患者14例,男性7例,女性7例,均行超声及DSA检查.回顾性分析本组患者的临床资料及超声影像资料,根据Bicetre外科学分型,以DSA作为金标准,将超声与DSA检查结果进行比较,评估超声诊断的准确性.结果 本组病例中EHPS型1例、PC型9例(ESPC 1例、SSPC 7例、HPC 1例)、PH型3例、PDV 1例;误诊1例为SSPC型;漏诊2例(1例为EHPS型,1例为PH型).与DSA检查结果比较,超声准确率为78.6％,其中EHPS、PC、PH和PDV的准确率分别为0.0％、88.9％、66.7％和100.0％,PC型的3个亚型ESPC、SSPC和HPC的准确率分别为100.0％、85.7％和100.0％.对于评估肝内门静脉分支发育情况,超声与DSA比较的准确率为85.7％.结论 彩色多普勒超声在先天性门-体静脉分流的诊断和分类中具有较高的准确性,并且能直观地显示分流的位置和初步评估肝内门静脉分支的发育情况,具有重要的影像学价值.

目的 评估超声排泄性尿路造影(CeVUS)在膀胱输尿管反流(VUR)诊断及分级评判中的准确性及超声观察者间分级的一致性.方法 纳入39例(共79个肾盂-输尿管单位)进行CeVUS及X线逆行尿路造影(VCUG)检查的患儿进行回顾性分析.以VCUG检查结果为金标准,计算CeVUS对VUR诊断的特异度、灵敏度及分级的准确率.以Kappa检验分析2名超声医师间对诊断VUR不同的超声征象及VUS分级评判的一致性.结果 79个肾盂-输尿管单位的CeVUS检查结果与VCUG比较显示,CeVUS诊断VUR的特异度为90.6％,灵敏度89.4％.42个显示反流的肾盂-输尿管单位的分级准确率为90.5％,其中Ⅱ、Ⅲ、Ⅳ及Ⅴ级的准确率分别为100％、80.0％、93.8％和90.9％.2名观察者对输尿管显影、输尿管扭曲、肾盂显影、肾盂扩张程度、肾盏显影、肾盏扩张程度、肾盏形态失常的判断的κ值分别为1.00、1.00、1.00、0.66(95％CI:0.52～0.80)、0.91(95％CI:0.82～1.00)、0.79(95％CI:0.70～0.89),0.69(95％CI:0.56～0.81).对VUS整体分级判断的一致性为0.87(95％CI:0.80～0.93).结论 CeVUS在对儿童VUR的诊断和分级上的准确率较高,且可避免辐射损害,应作为VUR诊断的首选检查和随访工具.应用CeVUS的VUR分级系统进行分级时,观察者间总体分级一致性极好,具有较好的临床应用价值.

Objective To explore the clinical value of color Doppler ultrasound in the diagnosis of testicular appendage torsion.Methods One hundred and thirty-seven children with acute scrotum were underwent surgery were enrolled in this study,their color Dopper ultrasonic data were analyzed retrospectively,the results was compared with that of the surgery, the specificity,sensitivity,positive predictive value,negative predictive value,accuracy and misdiagnose rate of ultrasound in diagnosis of were calculated.Results In 137 cases,124 cases of testicular appendage torsion were diagnosed by surgery,111 cases of testicular appendage torsion were diagnosed by color Doppler ultrasound.Ultrasound images showed that testicle and epididymis hypoechoic,iso-echoic or hyoerechoic nodule between the testicle and epididymis.Color Doppler flow imaging showed that there were no significant blood flow in the enlarged attachments,increaseed blood flow in testis and epididymis was found,with testicular sheath effusion and thicken scrotal wall.The specificity,sensitivity,positive predictive value,negative predictive value,accuracy rate,misdiagnose rateof ultrasound in diagnosis of testicular appendage torsion were 100%,89.5%,100%,50.0%,90.5%, respectively.Conclusion Color Dopper ultrasound has a certain clinical value in diagnosis of testicular appendage torsion,and can be used as the preferred imaging method in diagnosis of testicular appendage torsion.