Application Of Contrast-enhanced Ultrasound In Surgical Treatment Of Vesicoureteral Reflux In Children

Objective:To investigate the value of contrast-enhanced voiding urography(CeVUS)in the ureterovesical reimplantation treatment of vesicoureteral reflux(VUR)in children.Methods:From December 2018 to December 2020,159 children with recurrent urinary tract infection in our hospital were selected for CeVUS and VCUG(voiding cystrothrography)examination.And 78 children finally met VUR diagnosis.The CeVUS results showed that at least one side of the reflux degree was grade IV-V,in line with the "expert consensus on primary vesicoureteral reflux in children" issued by the urology group of pediatric surgery branch of Chinese Medical Association in 2019,children with VUR were treated with pneumatic bladder laparoscopic ureterourethral reimplantation,a total of 60 pyelo-ureter units.The general clinical data of all children were collected Epiq5 color Doppler diagnostic instrument,equipped with C5-1 convex array probe and L12-3 high frequency linear array probe,was used to obtain the renal volume,renal parenchyma thickness,renal sinus separation degree,ureteral dilatation,length and inner diameter of ureteral wall;contrast imaging technology and Sono Vue ultrasound contrast agent were used to obtain the reflux of children,and compared with VCUG to evaluate the VUR of children.CeVUS and VCUG were performed again at 6 months,12 months and 18 months after operation to evaluate the efficacy.The general clinical data of VUR children and non VUR children were compared,and their urinary ultrasound parameters were compared;the ROC curve of each parameter was drawn,and the area under was calculated.Kappa test was used to evaluate the consistency of CeVUS and VCUG in preoperative screening diagnosis,postoperative 6 months,12 months and 18 months curative effect evaluation;the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CeVUS in different levels of diagnosis at different times were calculated.Results:1.CeVUS has high sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the grading diagnosis of VUR in children.The sensitivity is more than 83%,and the specificity,accuracy,positive predictive value and negative predictive value are more than 93%.The kappa value was 0.966(P<0.001).2.In the comparison of general data,the number of male,family history and history of urinary tract infection in VUR children were significantly higher than those in non VUR children(P <0.05),the length of inner ureteral segment was significantly lower than that in non VUR children,and the inner diameter of inner ureteral segment was slightly wider than that in non VUR children(P<0.05).3.The results of urinary ultrasound ROC curve showed that the AUC values of the length and inner diameter of the ureteral wall were 0.652 and 0.738respectively(P <0.05).4.The results of follow-up showed that CeVUS had high sensitivity,specificity,accuracy,positive predictive value and negative predictive value.The sensitivity and specificity were above 71%,and the accuracy,positive predictive value and negative predictive value were above 92%.The kappa values were 0.889,0.856 and 0.815 at 6,12 and 18 months after operation,respectively(P<0.001).5.ROC curve results showed that the AUC values of the length of the inner ureteral wall at 6 months,12 months and 18 months after operation were all 1.000(P <0.05).6.The sensitivity and negative predictive value of CeVUS were 100%,the specificity was more than 71%,and the accuracy and positive predictive value were more than 92%.Kappa values were 0.886,0.856 and 0.815 respectively(P <0.001).Conclusion:CeVUS is a kind of accurate and safe examination method.It has high sensitivity,specificity and accuracy in the preoperative diagnosis,postoperative follow-up and curative effect evaluation of children’s VUR treated by laparoscopic ureterovesical reimplantation.Compared with VCUG method,CeVUS has high consistency,safety and no radiation.It can be used for the diagnosis,treatment mode selection,follow-up during treatment and late treatment of children’s VUR The evaluation of curative effect has extremely important clinical significance.