摘要
目的 确定病人和结石在非增强螺旋CT上的特点,预言2种体外冲击波碎石后的结果：结石分散状态（游离状态）或体外碎石成功.方法 回顾性分析200个相连续的用体外震波碎石治疗的肾结石患者.患者年龄、性别、结石侧别、体表面积、体重、结石最大容积、结石的平均CT值、结石密度、皮肤到结石距离,肾内结石的位置,研究这些潜在的预测因子.患者非肾脏、输尿管、膀胱手术后钙化,在第6周时拍腹部平片确定结石的分散状态,体外冲击波碎石成功者：结石残留碎片小于4mm.结果 发现肾内结石的位置是唯一一个预测体外碎石后结石分散状态的因子.肾盂、肾盂输尿管交界处结石清除率要高于肾盏结石;上盏或中盏结石清除率要高于下盏.结石大小、平均CT值和结石的位置能够预测体外震波碎石的成功率.小结石和低CT值结石更容易被击碎,在肾盏结石中更高的离散状态和体外碎石的成功率发现与更短的皮肤-结石距离有关,肾盂结石和肾盂输尿管交界处结石排除在分析之外.结论 结石的位置是体外震波碎石后获得结石离散状态最重要的因素,非增强螺旋结石特点：诸如结石大小、平均密度、结石肾内位置是体外震波碎石成功的重要预测因子.
Objectives To determine the patient and noncontrast computed tomography （NCCT） stone characteristics that predict either of 2 extracorporeal shock wave lithotripsy （ESWL） outcomes： stone - free （SF）status or ESWL success. Methods The records of 200 consecutive patients with nephrolithiasis treated with ESWL were reviewed. Patient age, sex, stone laterality, body surface area, body mass index, maximal stone dimension,mean stone Hounsfield units （HU）, stone Hounsfield density, skin- to- stone distance （SSD）, and intrarenal stone location were studied as potential predictors. Patients with no calcifications on postoperative kidneys, ureters,and bladder （KUB） at 6 weeks were defined as SF. ESWL success was defined as SF or remaining stone fragments less than 4 mm. Results lntrarenal stone location was found to be the only predictor of SF status. Renal pelvic/ureteropelvic junction （UPJ） stones cleared better than calyceal stones, and upper/middle calyceal stones cleared better than lower calyceal stones. Stone size, mean HU, and location predicted ESWL fragmentation success. Smaller stones and stones with lower mean HU levels were more successfully fragmented. Higher SF and ESWL success rates were found with a shorter SSD among calyceal stones when renal pelvic/UPJ stones were excluded from analysis. Conclusions Stone location is the most important factor in achieving SF status after ESWL. NCCT stone characteristics such as stone size, mean HU, and intrarenal location are important predictors of ESWL success.
出处
《国际泌尿系统杂志》
2011年第1期10-19,共10页
International Journal of Urology and Nephrology
关键词
肾结石
碎石术
Kidney Calculi
Lithotripsy
