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目的探讨CT值在预测经皮肾镜EMS碎石清石系统取石效率中的应用价值。方法收集该院2013年8月-2015年7月采用俯卧位标准通道经皮肾镜取石术(PCNL)治疗肾结石患者210例,术前CT扫描测定结石CT值。手术采用22Fr或24Fr通道、18Fr新型标准肾镜,以第四代EMS气压弹道联合超声碎石清石系统碎石取石,计算取石速度(ml/h)。术毕根据超声碎石难易程度及取石速度将210例患者分为A(难碎,取石慢)、B(中等)和C(易碎,取石快)3组,将3组结石的平均CT值分别进行比较,做统计学分析。结果 210例手术均顺利,取石速度18~85 ml/h,将取石速度<30 ml/h者分为A组,30~50 ml/h分为B组,>50 ml/h分为C组。A组共62例(29.5%),B组98例(46.7%),C组50例(23.8%)。3组结石平均CT值分别为(1 108.0±105.0)、(853.0±95.0)和(669.0±77.0)HU,各组间比较差异有统计学意义(P<0.01)。结论术前测定肾结石CT值对于经皮肾镜EMS碎石清石系统取石效率具有预测价值,CT值>1 100.0 HU者超声碎石清石效果欠佳,可考虑首选其他碎石工具。
Objective To investigate the value of CT in predicting the stone-removing efficiency of percutaneous nephrolithotrapic lithotripsy (EMS) gravel system. Methods Totally 210 patients with nephrolithiasis who underwent percutaneous nephrolithotomy (PCNL) in the prone position from August 2013 to July 2015 were collected. The CT value of calculus was measured before operation. Surgical use of 22Fr or 24Fr channel, 18Fr new standard nephrolithotomy with the fourth generation of EMS pneumatic ballistic lithotripsy lithotripsy gravel stone, calculate the stone speed (ml / h). According to the degree of difficulty and speed of ultrasonic lithotripsy, 210 patients were divided into three groups: A (hard crushing, slowly taking stone), B (moderate) and C Values were compared, do statistical analysis. Results All the 210 cases were operated smoothly, the stone speed was 18-85 ml / h, the speed of stone removal was <30 ml / h, group A was divided into group B, and the group of 50-50 ml / h was divided into group C . A group of 62 patients (29.5%), B group 98 cases (46.7%), C group 50 cases (23.8%). The average CT values of the stones in the three groups were (1 108.0 ± 105.0), (853.0 ± 95.0) and (669.0 ± 77.0) HU, respectively. The differences among the groups were statistically significant (P <0.01). Conclusions The preoperative CT value of renal calculus is predictive value for percutaneous nephrolithotomy lithotripsy system lithotripsy. The CT value> 100.0 HU is not good enough for ultrasound lithotripsy, so other lithotripsy tools may be the first choice.