术前CT平扫观察结石成分与经皮肾镜碎石术清石效果的关系

Relationship between stone composition detected by preoperative CT plain scan and the therapeutic effect of percutaneous nephrolithotomy

目的:分析术前CT平扫观察结石成分与肾结石经皮肾镜碎石术(PCNL)清石效果的关系。方法:纳入2016年1月至2018年1月于广东省中医院珠海医院收治的310例肾结石PCNL患者为研究对象,开展回顾性分析。按照术前CT平扫观察的结石成分,分为易碎石组(208例)、难碎石组(102例),并与术后实际结石清除率比较,观察术前CT判断与术后实际结石清除率的一致性。结果:310例肾结石患者术后结石清除288例(92.90%),其中一水草酸钙结石28例(9.72%),磷酸钙结石48例(16.67%),二水草酸钙结石91例(31.60%),磷酸镁铵结石70例(24.31%),尿酸结石51例(17.70%);310例肾结石患者术后未清除22例(7.10%),其中一水草酸钙结石7例(31.82%),磷酸钙结石9例(40.91%),二水草酸钙结石3例(13.64%),磷酸镁铵结石2例(9.09%),尿酸结石1例(4.54%)。易碎石组手术时间显著短于难碎石组(P<0.05),术中出血量、CT值显著低于难碎石组(P<0.05),住院时间较难碎石组无统计学意义(P>0.05);PCNL术后实际碎石效果显示清除组手术时间显著短于未清除组(P<0.05),术中出血量、CT值显著低于未清除组(P<0.05),住院时间较未清除组无统计学意义(P>0.05),证实术前CT判断与术后实际结石清除率存在一致性。术前CT判断结石清除效果灵敏度为71.53%,特异度为90.91%,准确率为72.22%,阳性预测值为99.04%,阴性预测值为19.61%,Kappa值为0.73。结论:术前CT平扫观察结石成分对PCNL的清石效果具有一定预测价值,临床上应引起足够重视。

Objective To analyze the relationship between stone composition detected by preoperative CT plain scan and renal stone removal by percutaneous nephrolithotomy(PCNL).Methods From January 2016 to January 2018,310 patients with renal stones who underwent PCNL in Zhuhai Hospital,Traditional Chinese Medicine Hospital of Guangdong Province were enrolled in this study.The stones were divided into the treatable group(208 cases)and refractory group(102 cases)according to the stone composition detected by preoperative CT plain scan.The stone-free rates in different groups were compared.The consistency between the preoperative CT judgment and the stone-free rate after operation was analyzed.Results Of 310 patients with renal stones,288 cases(92.90%)achieve renal stone removal,including 28 cases(9.72%)with calcium oxalate monohydrate stones,48(16.67%)with calcium phosphate stones,91(31.60%)with calcium oxalate dihydrate stones,70(24.31%)with magnesium ammonium phosphate stones,and 51(17.70%)with uric acid stones.The stones in the other 22 cases were not removed(7.10%),including calcium oxalate monohydrate stones in 7 cases(31.82%),calcium phosphate stones in 9 cases(40.91%),calcium oxalate dihydrate stones in 3 cases(13.64%),magnesium ammonium phosphate stones in 2 cases(9.09%),and uric acid stones in 1 case(4.54%).The operation time of treatable group was significantly shorter than that of refractory group(P<0.05),and the intraoperative blood loss and CT value of treatable group were significantly lower than those of refractory group(P<0.05).No statistical significance was found in hospital stay between two groups(P>0.05).According to the outcomes of PCNL,the patients were divided into stone group in which the stones were not removed and stone-free group in which the stones were removed.Compared with stone group,stone-free group had significantly shorter operation time(P<0.05),and obviously decreased intraoperative blood loss and CT value(P<0.05),and there were no statistical differences in hospital stay between two groups(P>0.05).The consistency between the preoperative CT judgment and the stone-free rate after operation was confirmed.The sensitivity,specificity,and accuracy of preoperative CT judgment for stone removal were 71.53%,90.91%and 72.22%,respectively.The positive and negative predictive values of preoperative CT judgment were 99.04%and 19.61%,respectively,and the Kappa value was 0.73.Conclusion Preoperative CT plain scan which has certain predictive value for the therapeutic effect of PCNL should be paid enough attention in clinic.