体外冲击波碎石对不同部位肾结石非靶区血流量、表面通透性的影响及效果比较

Effect of extracorporeal shock wave lithotripsy on non-target area blood flow and surface permeability in different parts of kidney stones and its effect comparison

目的探讨高能冲击波体外碎石技术治疗对不同部位肾结石患者非靶区血流量、表面通透性的影响及效果。方法选择2015年1月~2017年6月广东省惠州市第一人民医院泌尿外科收治的肾结石患者168例作为研究对象,根据肾结石部位分为肾上盏组(110例)、肾下盏组(58例)。均采用高能量的冲击波(E=12~15 k V)行体外碎石。术前术后对两组非靶区肾脏做CT灌注扫描,比较两组非靶区肾脏的血流量(BF)、表面通透性(PS)变化。比较两组术后并发症发生情况及排石成功率。结果术前术后两组非靶区肾脏CT灌注参数BF、PS组间及组内比较,差异均无统计学意义(P>0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05);但肾上盏组绞痛、发热发生率明显高于肾下盏组,肾下盏组血尿、石街发生率明显高于肾上盏组,差异均有统计学意义(P<0.05)。肾上盏组排石成功率高于肾下盏组,差异有统计学意义(P<0.05)。结论高能量冲击波体外碎石对于不同部位的肾结石患者的非靶区肾脏损伤较为轻微,但肾上盏、肾下盏部位术后并发症情况不同。高能量冲击波体外碎石对于肾上盏区的肾结石的疗效则优于肾下盏区。

Objective To explore the effect of high energy shock wave extracorporeal lithotripsy on patients with different parts of renal calculi. Methods A total of 168 patients with kidney stones in Department of Urology, First People′s Hospital of Huizhou from January 2015 to June 2017 were selected as the research objects and divided into the suprarenal calyx group（110 cases） and inferiorrenal calyx group（58 cases） according to position of the stone. All the patients were treated with high energy shock wave（E = 12-15 k V） for extracorporeal lithotripsy. According to the renal calculi, CT perfusion scanning was performed on the non-target kidneys in both groups before and after surgery. The non-target renal blood flow（BF）, surface permeability（PS） changes, postoperative complications and the stone success rate were compared between the two groups. Results There were no statistically significant differences in the CT perfusion parameters of BF and PS in non-target areas between the two groups and within groups（P〉0.05）. There was no statistically significant difference in the total incidence of complications between the two groups（P〉0.05）. However,the incidence of colic and fever in the suprarenal calyx group were significantly higher than those of inferiorrenal calyx group, and the incidence of hematuria and stone streets in inferiorrenal calyx group were significantly higher than those of suprarenal calyx group, with statistically significant differences（P〈0.05）. The success rate of stone in the suprarenal calyx group was higher than that of inferiorrenal calyx group, with statistically significant differences（P〈0.05）. Conclusion High energy shock wave extracorporeal lithotripsy has less damage to non-target kidney in patients with different parts of renal calculus, but there are different postoperative complications in suprarenal renal calyx and inferiorrenal calyx. The effect of high energy shock wave extracorporeal lithotripsy in stone of suprarenal calyx is better than that of inferiorrenal calyx.