CT值预测泌尿系结石体外冲击波碎石效果的实验研究  

Computed Tomography value of urinary stone predicts outcome of extracorporeal shock wave lithotripsy:an experimental study

作　　者：李泰勋 田素建 邵光景 杨森 王富军[1] Li Taixun;Tian Sujian;Shao Guangjing;Yang Sen;Wang Fujun(Department of Urology,Heze Municipal Hospital,Shandong 274000,China)

机构地区：[1]山东省菏泽市立医院泌尿外科,274000

出　　处：《实用医技杂志》2022年第12期1278-1280,共3页Journal of Practical Medical Techniques

摘　　要：目的 探讨CT值在预测体外冲击波碎石效果方面的应用价值。方法 收集2020年1月至2022年6月菏泽市立医院经皮肾镜弹道碎石手术患者的结石。血管钳修剪结石,使其直径约5 mm。将结石放入仿真人体模型并对人体模型行CT扫描,分别计算每个结石的CT值,对比术前患者体内结石的CT值。分别将结石放入透明橡胶套内,然后将装有结石的橡胶套放入人体模型中的肾脏内,进行冲击波碎石。观察碎石效果,分4类:①未碎,结石接近碎石前大小,水中仅有少量粉末;②部分粉碎:结石成块状,最小块状长径>2 mm,但≤4 mm。③粉碎:结石成小块状与粉末状,最大块状长径不超过2 mm。④完全粉碎,结石完全粉末化。“部分粉碎”“粉碎”“完全粉碎”归为碎石成功组,“未碎”归为碎石失败组。分析CT值与体外冲击波碎石效果的关系。结果 共选取100枚结石,体外模拟环境中结石CT值范围970~1 720 Hu,每枚结石CT值平均高于相对应患者术前体内结石CT值206.33 Hu。56枚体外碎石成功,CT值(1 200±206)Hu,其中22枚完全粉碎,CT值(1 000±36)Hu;18枚粉碎,CT值(1 100±68)Hu;16枚部分粉碎,CT值(1 300±94)Hu。44枚碎石失败,CT值(1 500±236)Hu。低CT值的结石体外碎石效果好于高CT值的结石,差异有统计学意义(P<0.05)。结论 结石CT值越高其体外碎石效果越差,对于体内结石CT值高于1 300 Hu的患者,体外碎石无效。Objective To investigate the usefulness of Computed Tomography(CT)value in predicting the outcome of extracorporeal shock wave lithotripsy(ESWL).Methods From patients who underwent percut-aneous nephrolithotripsy(PCNL)between January 2020 and June 2022 from Heze Municipal Hospital,urinary stones were collected,trimmed with forceps to nearly 5mm in size,and placed in a simulated mannequin which was then subjected to CT scan.The CT value of each stone was measured and compared to that prior to PCNL in vivo.Next,each stone,contained separately in a condom,was put insided the kidneys of the mannequin for ESWL.The outcome of ESWL was categorized as unbroken(the stone almost retained its pre-ESWL size,only with a tiny amount of powder in the water),partially broken(the stone broke into pieces,with the smallest one measuring above 2 mm but no greater than 4 mm in size),crushed(the stone turned into a mixture of tiny pieces and powder,with the largest piece measuring no greater than 2 mm),and powdered(the stone completely became pulverized).ESWL sessions leading to stones"partially broken","crushed"and"powdered"were defined as successful,while those with"unbroken"stone as failure.The relationship between CT value and the outcomes of ESWL was analyzed.Results A total of 100 stones were studied.In vitro,these stones measured 970 Hu to 1720 Hu on CT,each with a higher CT value of 206.33 Hu on average compared with the pre-PCNL CT value in the same patient.The ESWL was successful for 56 stones with a CT value of(1200±206)Hu;of these,22 were powered witha CT value of(1000±36)Hu,18 crushed with a CT value of(1100±68)Hu,16 partially broken with a CT value of(1300±94)Hu.Forty-four stones failed the ESWL with a CT value of(1500±236)Hu.The outcomeof ESWL was more favorable for stones with low CT value than for those with high CT value,presenting a statisti-cally significant difference(P<0.05).Conclusion Higher CT value of urinary stone is associated with worse out-come of ESWL.Patients with urinary stones higher than 1300 Hu

关 键 词：肾结石 体层摄影术 螺旋计算机 碎石术 实验研究 

分 类 号：R699[医药卫生—泌尿科学]