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초음파촬영술에 의한 한국인 정상성인 및 수신증 환자의 신장계측에 관한 연구

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[한글] 저자는 초음파촬영술을 정상성인 및 수신증 환자에서 시행하여 배설성요로조영술과 비 교관찰하였으며, 신위축을 일으키는 질환 및 신비대를 초래하는 질환에서 가장 큰 진단적 가치를 가지는 신장의 크기 및 실질의 두께를 측정하여 다음과 같은 결론을 얻었다. 1. 정상신장에 있어 배설성요로조영술과 초음파촬영술의 비교에서 신종경은 우신의 경 우 12.2±0.45cm 및 11.4±0.55cm이었으며 그 차이는 0.8cm(t value : 2.21, p<0.02), 좌 신의 경우는 12.6±0.78cm 및 11.9±0.42cm로써 그 차이는 0.7cm(t value : 2.43, p<0.02 )이었다. 신횡경은 우신은 6.3±0.61cm 및 5.4 ±0.57 cm로 그 차이는 0.9cm(t value; 1. 75, p<0.1), 좌신은 6.3±0.49cm 및 5.6±0.58 cm로 차이는 0.7cm (t value : 1.82, p<0. 1)이었다. 신실질의 두께는 우신의 경우 2.1±0.56 cm 및 2.1±0.57 cm로 차이가 없었고 ( t value : 2.89, p<0.001), 좌신도 2.2±0.48cm 및 2.1±0.54cm로 차이가 없었다(t val ue: 2.31, p<0.05). 2. 32례의 수신증례중 배설성요로조영술로 진단이 가능하였던 17례의 수신증의 경우 배 설성요로조영술과 초음파촬영술의 비교에서 경도의 수신증시 신종경은 12.8±0.46cm 및 1 2.2±0.56cm이었으며 그 차이는 0.6cm이었으며, 신횡경은 6.4±0.38cm 및 6.1±0.27cm로 그 차이는 0.3cm이었으나, 신실질의 두께는 2.1±0.49cm 및 2.1±0.34cm로써 차이가 없었 다. 중등도 수신증에서 신종경은 14.2 ±0.67cm 및 13.5 ± 0.47cm로 그 차이는 0.7cm이 었고, 횡경은 7.8±0.73 cm 및 7.2±0.58cm로 그 차이는 0.6cm이었고, 신실질의 두께는 1 .4±0.27cm 및 1.2± 0.57cm로 그 차이는 0.2cm이었다. 심한 수신증에서 신종경은 16.6± 0.53cm 및 15.7±0.39cm로 그 차이는 0.9cm이었으며, 신횡경은 9.5±0.48cm 및 8.8±0.46 cm로 그 차이는 0.7cm이었다. 신실질의 두께는 배설성요로조영술에서는 계측이 불가능하 였으나 초음파촬영술은 0.7±0.27cm이었다. 3. 32례의 수신증 환자중 배설성요로조영술상 불현신 15례의 경우에서 초음파촬영술로 신장의 크기 및 신실질의 두께를 비교적 정확히 측정할 수 있었다. 이상과 같은 결과로 미루어 보아 신장의 초음파촬영술은 신장의 크기와 모양을 관찰하 는데 유용하며, 수신증 환자에 대한 진단초기과정에서 신장의 해부학적 구조를 규명하는 데 있어 다른 침습성 진단방법에 우선하여 사용할 수 있는 방법이라고 생각한다.
[영문] Advances in gray scale ultrasonography have increased the usefulness of their modality in the clinical diagnostic method . Major improvements in the image resolution have greatly increased the diagnostic value of renal ultrasonography. The non-invasive and safe nature of ultrasound makes this technique ideal for accurate and quick evaluation. It has been well known facts that it is very difficult to obtain precise size, shape and parenchymal thickness of the kindeys by conventional radiological techniques such as retrograde pyelography, antergrade percutaneous pyelography or arteriography and also the techniques are invasive to patients comparatively. Because of its simplicity, innocuousness and accurateness, diagnostic ultrasound is quite useful in the evaluation of functionally inactive kidney and should precede or be substitute for other aggressive technique. In those kidneys which remain unseen even after massive dose of dye, the ultrasound scan should be used before retrograde ureteral catheterization is undertaken. The author measured the size of kidney longitudinally, transversely and in thickness by ultrasonogram and compared with that of excretory urogram in 60 normal healthy persons and 32 cases of hydronephrosis. The results were obtained as follows: 1. The length of right kidney on ultrasonogram(11.4±0.55cm) was smaller than on excretory urogram(12.2±0.45cm) and the difference was 0.8cm(t value: 2.21, p<0.02), and the length of left kidney on ultrasonogram(11.9±0.42cm) was smaller than on excretory urogram(12.6±0.78cm) and the difference was 0.7cm (t value: 2.43, p<0.02). The width of right kidney on ultrasonogram(5.4±0.57cm) was smaller than on excretory urogram(6.3±0.61cm) and the difference was 0.9cm(t value: 1.75, p<0.1) and the width of left kidney on ultrasonogram(5.6±0.58cm) was smaller than on excretory urogram(6.3±0.49cm) and the difference was 0.7cm(t value: 1.82, p<0.1). The parenchymal depth of right kidney on ultrasonogram(2.2±0.48 cm) was larger than on excretory urogram(2.1±0.56 cm) and the difference was 0.1cm(t value: 2.89, p<0.001), and the parenchymal depth of left kidney on ultrasonogram(2.1±0.54 cm) was alike on excretory urogram(2.1±0.57cm) and there was no difference(t value: 2.31, p<O.05). 2. Among 32 cases of hydronephrosis, 17 cases were hydronephrosis on excretory urogram. In mild hydronephrosis among them, the length of kdiney on ultrasonogram(12.2±0.56cm)was smaller than on excretory urogram(12.8±0.46cm) and the difference was 0.6cm, the width of kidney on ultrasonogram(6.1±0.27cm) was smaller than on excretory urogram(6.4±0.38cm) and the difference was 0.3cm, and the parenchymal depth of kidney on ultrasonogram(2.1±0.34cm)was alike on excretory urogram(2.1±0.49 cm) and there was no difference. In moderate hydronephrosis, the length of kidney on ultrasonogram(13.5±0.47cm) was smaller than on excretory urogram(14.2±0.67cm) and the difference was 0.7cm, the width of kidney on ultrasonogram(7.2±0.58cm) was smaller than on excretory urogram(7.8±0.73cm) and the difference was 0.6cm, and the parenchymal depth of kidney on ultrasonogram(1.2±0.57cm) was smaller than on excretory urogram(1.4±0.27cm) and the difference was 0.2cm. In severe hydronephrosis, the length of kidney on ultrasonogram(15.7±0.39cm) was smaller than on excretory urogram(16.6±0.53cm) and the difference was 0.9cm, the width of kidney on ultrasonogram(8.8±0.46cm) was smaller than on excretory urogram(9.5±0.48cm) and the difference was 0.7cm, and the parenchymal depth of kidney on ultrasonogram was 0.7±0.27cm but could not be measured on excretory urogram. 3. Among 32 cases of hydronephrosis , 15 cases were non-visualized kidney on excretory urogram. On them, relatively accurate renal size and parenchymal depth were measured by ultrasonography. By reviewing the above results the ultrasonography of the kidney is useful in measurement of the kidney size and can be substitute for invasive uroradiological methods in evaluation of patients with hydronephrosis.
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