螺旋CT三维重建技术在输尿管软镜联合钬激光治疗肾下盏结石术中的应用价值

The application value of MSCT 3D reconstruction technique in flexible ureteroscopy and holmium laser subrenal calyx lithotripsy

目的探讨螺旋CT三维重建技术在输尿管软镜联合钬激光治疗肾下盏结石术中的应用价值。方法回顾性分析采用输尿管软镜联合钬激光治疗的67例肾下盏结石患者临床资料，通过螺旋CT三维重建技术，测量肾盂肾下盏漏斗部夹角（IPA）、肾下盏宽度和长度、（结石所在）肾下盏盏颈／肾盏横颈最小比值（minN/T），并探讨影响治疗成功率的因素。结果67例患者中，治愈52例（治愈组），未治愈15例（未治愈组），治愈组IPA和minN/T均明显大于未治愈组[（54．12±21．32）°比（42．12±22．68）°和0．63±0．18比0．51±0．23]，差异有统计学意义（P〈0．05）。26例同时行螺旋CT和静脉尿路造影术（IVU）检查，螺旋CT三维重建测量的IPA高于IVU测量的IPA[（53．12±10．16）°比（47．67±11．25）°]，差异有统计学意义（t=1．676，P〈0．05）。Logistic回归分析结果表明，IPA和minN／T是输尿管软镜联合钬激光治疗肾下盏结石疗效的影响因素（P〈0．05）。结论螺旋CT三维重建图像能更准确地观察肾下盏解剖结构，而且IPA和minN／T与输尿管软镜联合钬激光治疗成功率有关，对于术前准确评估手术适应证具有指导意义。

Objective To explore the application value of MSCT 3D reconstruction technique in flexible ureteroscopy and holium laser lithotripsy （FURL） for subrenal calyx calculus. Methods Data of 67 subrenal calyx calculus patients treated with FURL were analyzed retrospectively. The anatomic difference between surgically cured group and uncured one was compared by measuring the renal pelvis subrenal calyx infundibulopelvic angle （IPA）, the calyx width and length, as well as the minimum ratio of subrenal calyx neck width and calyx transverse diameter （minN/T） with MSCT 3D reconstruction technique. The anatomic structure factors that may impact the operative success rate were discussed. Results Among the 67 patients, 52 patients were cured and in cured group, and 15 patients were in uncured group. The average IPA value in cured group was significantly higher than that in uncured group： （54.12± 21.32）° vs. （42.12 ± 22.68）°, and there was significantly difference （P〈0.05）. Twenty-six patients performed CT 3D reconstruction and IVU examination at the same time. The level of IPA in CT 3D reconstruction was significantly higher than that in IVU examination ： （53.12 ± 10.16）° vs. （47.67 ± 11.25）°, and there was significant difference （t = 1.676, P 〈 0.05）. Logistic regression analysis showed that IPA and minN/T levels were the influencing factors of FURL for subrenal calyx calculus. Conclusions The MSCT 3D reconstruction technique can better describe the anatomical relationship of the subrenal calyx. The success rate of FURL relates to the IPA value and the min N/T, which is significant in preoperative indication evaluation.