CT值在输尿管结石ESWL术中的应用价值探讨

Value of CT values in ureteral calculi ESWL surgery

目的利用非增强螺旋CT(non-contrast helical computerized tomography,NCHCT)测定结石的CT值,结合输尿管结石体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)疗效,探讨CT值在临床中应用价值。方法对79例输尿管结石长径在0.6～1.5 cm拟行ESWL治疗的输尿管单发结石患者,行非增强螺旋CT检查并测定结石的CT值,分为平均CT值<750 HU组和平均CT值>750 HU组,经过ESWL术后,观察两组结石清除率及有效率,分析两组间的基本特征和冲击次数及碎石效果。结果与结石CT值>750 HU组相比,<750 HU组所需冲击次数少,结石清除率高。两组比较(P<0.05),差异有统计学意义。结论 NCHCT的结石平均CT值能有效预测输尿管结石ESWL术疗效。结石CT值<750 HU易于粉碎,结石清除率高,应首选ESWL术;而CT值>750 HU结石清除率低,可考虑首选腔镜下碎石或开放手术取石。

Objective To study the clinical application value of CT through the use of non- enhanced spiral CT （non- con- trast helical computerized tomography （NCHCT） ） for determination of CT values of calculi combined with the efficacy of ureteral calcu- lus ESWL. Methods Seventy - nine patients with nreteral calculi at length between 0.6 - 1.5 cm, underwent non - enhanced spiral CT examination and determination of the CT values of the stones. They were divided into the average CT value 〈 750 HU group and the average CTvalue 〉 750 HU group. After ESWL, the stone clearance rate and efficiency were observed in the two groups, and the basic characteristics between the two groups and the number of lithotripsy and effect were analyzed. Results The CT value and stone 〉 750 HU group, compared with 〈 750 HU group needed less number of lithotripsy and high stone - free rate ; the difference was statistically significant between the two groups （P 〈 0.05 ）. Conclusions NCHCT stone average CT value can effectively predict ureteral calculi ESWL curative effect. Stone CT value 〈 750 HU is easy to be broken to pieces, with high stone clearance rate, should employ ESWL as first choice, where as CT value 〉 750 HU with low stone -free rate, should consider first the endoscopic lithotripsy or open surgery.